Has your doctor talked to you about getting an epidural for labor pain? You’ve probably heard conflicting things about whether epidurals slow down labour or not. Research is mixed, but the impact seems to be relatively small for most women. Before you go into labour, it’s good to know the facts so you can make the choice that’s right for you.
Women who want an epidural are often encouraged to wait until they are in active labour – around 5cms dilated. It has long been known that epidurals prolong the second stage of labour, also known as the pushing stage.
Epidurals are the most common pain relief used during labour, with about half of all women opting for this type of anaesthesia. The good news is, it’s very effective at eliminating discomfort during childbirth for the majority of women. The potential downside is that it may lengthen the second stage of labor (pushing) by a small amount. The first stage (before pushing) is less likely to be affected. Epidurals can also sometimes cause side effects like itching or dizziness.
Whether the possible risks of a longer labour are worth it for you depends on your priorities and pain tolerance. Many women find the benefits of an epidural, outweigh the potential downsides. But for some women, a natural unmedicated birth is very important. As with any medical intervention, you have to weigh all the pros and cons and go with what feels right for you.
What is an Epidural
An epidural is a regional anesthesia that blocks pain in a specific area of your body. Administered by an anesthesiologist, an epidural involves inserting a catheter into the epidural space in your spine to deliver pain medication.
Once in place, the medication numbs the nerves that carry signals from your uterus and birth canal to your brain. This allows you to remain alert during labor and delivery without feeling pain. Many women report feeling pressure but no pain.
Epidurals do not stall labour. While they may cause a temporary drop in blood pressure, epidurals do not affect your ability to push or progress labour. The effects of an epidural typically last for up to 6 hours before another dose of medication may need to be administered. After delivery, the catheter is removed and sensation slowly returns over the next few hours. Epidurals provide highly effective pain relief for most women and allow you to be present during your baby’s birth.
How Epidurals Work to Relieve Labour Pain
When you are administered an epidural, an anesthesiologist injects medication into the space around your spinal cord to block the pain signals from your uterus and birth canal. The meds numb you from the waist down, allowing you to rest during what can be a long labor.
- An epidural takes about 30 minutes to place and starts working within 10 to 20 minutes. The pain relief typically lasts throughout labour and delivery.
- Epidurals may slow down labor or increase the risk of a need for a C-sections. Some studies show they may even shorten the pushing stage. The myth that epidurals stall labor comes from the fact that it can take time for labour to progress after the water breaks or labour is induced.
- You’ll still feel pressure, but no pain. This allows you to rest, focus your energy on pushing when it’s time. Some women report shivering, itching, or nausea as side effect, but epidurals are safe when administered by an experienced anesthesiologist.
- An epidural does limit your mobility, so you’ll be confined to your bed. But being pain-free helps most women relax during what can be an anxious time. For many expectant mothers, the benefits of pain relief and rest far outweigh this temporary loss of mobility.
- When it’s time to push, your epidural can be “topped up” or adjusted to allow for a comfortable delivery. Be assured, with the help of your team guiding you through, you’ll get the job done!
Studies and Research – Do Epidurals Slow Down Labour
Research shows that epidurals can slow down labor for some women. Several studies have found that epidurals are associated with longer labor times, especially for first-time mothers. One large review of randomized trials found that epidurals increased the average length of the second stage of labor (pushing) by about 15-20 minutes. Another study found that epidurals tripled the risk of labor lasting more than 5 hours.
Another study has shown the time added to labour by the use of epidurals might be much more than originally thought.
It was previously believed epidurals lengthened labour by about one hour. Researchers looked at more than 42 000 women in California who gave birth vaginally between 1976 and 2008, and compared the length of the second stage of labour in women who had received epidurals with those who hadn’t.
In the study, women who were having a baby for the first time with an epidural in place took almost 2.5 hours longer to go through second stage than women without an epidural.
Women who had given birth before with an epidural in place took almost 3 hours longer to get through second stage than women without an epidural.
This information could have a significant impact on the number of women who will have a c-section after having an epidural placed. Often a c-section is performed because care providers decide labour is taking too long. If an epidural is in place, women might be given more time for the second stage, and therefore avoid having surgery.
It is not known exactly how epidurals prolong labour but there are several theories. Epidurals can interfere with the release of oxytocin, the hormone responsible for effective and strong uterine contractions. During the second stage of labour, the uterus is pushing down on the baby with strong contractions, moving the baby through the completely dilated cervix and into the birth canal.
When an epidural is in place, the descent of the baby is significantly slower, compared with when there is no epidural.
It is also possible the anaesthetic medication used causes muscles to relax, and numbs vital nerves in the pelvis. While the baby is descending through the vagina, nerves are triggered; they send messages to the brain to release large surges of oxytocin. This stimulates the Ferguson’s reflex, which is the uncontrollable expulsion of the baby in two or three strong contractions.
If these nerves can’t send their messages to the brain, the baby’s descent is delayed, and the mother might need to push forcefully with each contraction. This takes a lot of energy and could contribute to an even slower second stage.
Other Factors That Contribute to Longer Labour
Several other factors may have an impact on labour duration than epidurals. The position of the baby and its size and station in the birth canal play a large role. If the baby is facing up or sideways instead of face down, labor tends to take longer. The same is true if the baby is especially large. The lower the baby’s station, or how far down it has descended into the pelvis, the longer labor will probably last.
Other factors include:
- The strength and frequency of contractions. Less intense or irregular contractions slow labor.
- How much a woman moves around or walks during early labor. Mobility and changing positions helps labor progress.
- A woman’s pelvic shape and flexibility. A narrow pelvis or one that isn’t very flexible can prolong labor.
- Emotional state and environment. Feeling fearful, tense or anxious and a stressful environment inhibits the release of oxytocin and can stall labor. Relaxing, deep breathing and a calm environment speed things along.
So while epidurals may slow down labour times slightly, a number of other elements have an influence over how quickly or slowly a woman progresses through labour and delivery. Focusing on the factors within a woman’s control, like movement, relaxation and environment, can help reduce worries over epidurals and speed up labor.
Choosing to have an epidural is a very personal decision. Many women wish to have the option of an epidural during labour, but should be aware of the possibility of labour being longer than what is considered normal – especially during the second stage. Make sure your care provider is aware of the risks of epidurals prolonging labour, to avoid the cascade of intervention which might lead to c-section.
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