Labor Pains: Study Shows Mothers Should Control Own Epidural during Childbirth

Ever since the dawn of time, childbirth has been a painful experience for most women. As time goes by, we as a humane-human race seek to alleviate some of the trauma and suffering women go through with painkilling medicine. A recent study, however, reports that new mothers would rather have control over their intake of epidural infusion as opposed to being connected to a continuous flow.

Most would believe that this would cause the budding mothers to increase the dosage of the pain killer, but on the contrary, new findings show that a smaller amount of the painkiller is distributed this way. This is significant because the potential harmful side-effects of the drugs are kept to a bare minimum and mothers are still feeling the same amount of pain relief.

The term “epidural” is often short for epidural analgesia, a type of regional analgesia which involves an injection of drugs through a catheter placed into the epidural space. The injection can cause both numbness and an absence of pain by blocking the transmission of signals through nerves in or near the spinal cord.

A patient receiving an epidural for pain relief usually receives a combination of local anesthetics and opioids; this combination works better than either type of drug used alone. Common local anesthetics include: lidocaine, bupivacaine, ropivacaine, and chloroprocaine. Common opioids include: morphine, fentanyl, sufentanil, and pethidine (also known as meperidine in the U.S.) which are all injected in moderately small doses.

As stated by Medicalnewstoday.com, “Epidural typically involves using the opiates fentanyl or sufentanil, with bupivacaine. Fentanyl is a powerful opiate with potency and side affects 80 times that of morphine. Sufentanil is another opiate, 5 to 10 times more potent than Fentanyl. Bupivacaine is markedly toxic, causing excitation: nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, or seizures, followed by depression: drowsiness, loss of consciousness, respiratory depression and apnea. Bupivacaine has caused several deaths by cardiac arrest when epidural anesthetic has been accidentally inserted into vein instead of epidural space in the spine.”

One of the study's authors, Michael Haydon, M.D., stated that he and his team of researches had performed the first double-blind study “excluding inductions and including only women who were delivering for the first time, so that we could get a good sample of women with similar labor patterns.”

During childbirth, women often receive an uninterrupted epidural infusion of analgesic, which has the possibility of leading to prolonged labor and an increase in assisted vaginal delivery. Several pain management studies have been conducted to begin looking at how much analgesia women use and what their pain experience is like when they are able to administer it themselves.

The study concluded that the patient-controlled epidural analgesia, or PCEA, resulted in 30% less analgesia being used while maintaining high maternal satisfaction. There was also a trend toward reduction in instrumented vaginal deliveries in the PCEA only group.

Haydon, while pleased with the study and its results, said there was more to be done.

“Though patients in each group showed equal satisfaction, we did note that there was more pain during the final delivery stage in the patient-controlled epidural analgesia group,” said Haydon; “The next step is to look at shortening the lock-out intervals between doses, or having the option of administering additional analgesia during the final pushing stage,” which could result in “automated analgesia delivery” in reaction to patient necessity.