Family Matters

Pregnant Women Who Control their Epidural Dosage Use Less Medication

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Ah, the wonders of an epidural. Within minutes, that chilly infusion of bupivicaine and fentanyl can transform the raving, pain-wracked process of birthing a baby into a pleasant hospital stay with some energetic pushing that yields a beautiful bundle.

More than half of women opt for epidural analgesia during labor, and now, a new study has found that expectant moms who are allowed to control the dosage use less medication than those who receive a continuous infusion. (More on Doctor’s Orders: Sex During Pregnancy Gets the Green Light)

This is good news because epidurals, despite having made labor more bearable for scores of women, have their pitfalls: they can lead to prolonged labor and an increase in vacuum and forceps deliveries. They can also result in more C-sections, which is far from ideal.

Researchers at Long Beach Memorial Medical Center in Long Beach, Calif., divided 270 women into three groups — those who had a traditional epidural that continuously supplied relief, those who could control the administration of pain meds by pressing a button every 20 minutes and a combination group. The patient-controlled group used 30% less medication while reporting that they remained comfortable, although they did describe more pain during the actual pushing stage. The research was presented Thursday at the Society for Maternal-Fetal Medicine’s annual meeting in San Francisco.

How the analgesia was delivered did not affect the length of labor, but putting women in charge of their epidural delivery did result in a slightly lower C-section rate, 26% in comparison to 30% for the traditional method. (More on Time.comToo Many Babies Are Delivered Too Early: Hospitals Should Just Say No

Appropriately administering epidural analgesia is an art. Not enough, and the patient complains, loudly. Too much, and the mom is so numb that she can’t help toward the end when she needs to bear down and push her baby out.

Hospitals typically rely on continuous epidural infusions, although surveys indicate that about 30% have transitioned to patient-controlled epidurals. Some hospitals and doctors have expressed concern that anesthesiologists, who plunge the epidural catheter into a woman’s spine, might need to keep returning to a patient’s bedside to supplement her own patient-controlled supply.

The amount of self-medication is not unrestricted, after all. “When pushing the button, there is an upper limit,” says Michael Haydon, the study’s lead author and a perinatologist at Long Beach. “But the number of times an anesthesiologist had to give them additional doses was no different between groups.” (More on Time.comOperating on Babies in the Womb: For Spina Bifida, It’s the Better Option)

Of all the groups, the women who relied on both traditional and patient-controlled analgesia reported the greatest comfort. Sounds like the best of both worlds.

Haydon says he expects more hospitals to increasingly put women in charge of managing their labor pain. It’s been a while since I gave birth, so I asked my husband whether he recalled if I was in control of my epidural dosage during any of the three times I delivered one of our children. His response: “You wish.”