The Right Time to Give an Epidural

Let each patient decide when to have an epidural during childbirth. That's the advice of the Cochrane Pregnancy and Childbirth Group based on a recent meta-analysis.

Because there isn’t a known benefit, or drawback, to the timing of an epidural, providers should not dictate when women receive the pain-controlling injection according to a meta-analysis published in The Cochrane Database of Systematic Reviews.

Key Points

- The timing of an epidural seems to have no impact on the duration of labor or the likelihood of C-section.

- For your patients who want an epidural, let them choose the timing.

"The right time to give the epidural is when the woman requests pain relief," said lead researcher Ban Leong Sng, MBBS, who is also the Deputy Head and Senior Consultant of the Department of Women’s Anaesthesia, KK Women's and Children's Hospital (KKH), Singapore. "If they request an epidural early during their labour, the evidence we have does not provide a compelling reason why this should be refused."

The advice contradicts some previous evidence that suggested early epidurals could prolong labor and increase C-section rates. But when the Cochrane researchers reviewed data from nine studies, they didn’t find evidence to support either claim.

For the review, 15,752 first-time mothers who received epidurals were randomly assigned to receive the pain relief “early” (at less than 4 to 5 centimeters dilated) or “late” (they waited until they were at least 4 to 5 centimeters dilated). Those who had early epidurals were no more or less likely to need a C-section than those who had late epidurals, the researchers concluded. Furthermore, the timing of the epidural had no impact on the likelihood of needing an assisted birth involving forceps or suction or on the amount of time spent in the second stage-the pushing stage-of labor, the authors noted.

In addition, Apgar scores and cord pH for the baby were not different between the early and late groups.

One question that remains is if the timing of an epidural has an impact on the time it takes for a woman to reach full cervical dilation.

"We can't rule out the possibility that starting epidural pain relief earlier may lead to shorter labour," said Sng in a prepared release. "This is because there was a lot of variation in the results of the studies we looked at in terms of the length of the first stage of labour."

The reality, however, is that despite when a woman wants anesthesia or when the OB orders it, the timing depends on when anesthesia shows up.