Self-Administered Epidurals Seem to Ease Childbirth Pain

Women who control the amount of epidural anesthesia they get during labor and delivery use approximately 30 percent less medication than when given a standard dose from a doctor, according to a new study. “We looked at patient-controlled epidural anesthesia, and found the women were basically as comfortable as women on a continuous dose, and there was a 30 percent reduction in the amount of anesthesia used,” said Dr. Michael Haydon, the study’s author and a perinatologist at Long Beach Memorial Medical Center in California.

Epidurals are a common form of anesthesia administered during childbirth, according to the American Congress of Obstetricians and Gynecologists.  With an epidural, a small catheter is inserted into the spine’s epidural space, and a painkiller is then infused to numb the area.  Epidurals have a low risk of side effects, which can include nausea, backache, sudden drops in blood pressure, severe headache and more difficulty pushing (often resulting in the need for forceps or a Cesarean delivery), according to the American Pregnancy Association.

The study included 270 women, with two-thirds being given a steady infusion of drugs, while the other third was given a hand-held controller so the anesthesia could be delivered as needed.  The women could not keep requesting extra pain relief, as each press of the button delivered a dose, then “locked out” additional presses for a set period.  While there were no differences in the duration of labor, those using “patient-controlled epidural analgesia” (PCEA) used approximately 30 percent less anesthetic.  Patient satisfaction was generally the same, although the women who self administered the drugs did report more pain during the final stage of labor.  Additionally, there was some evidence that forceps deliveries were fewer in the PCEA group.

“My personal belief is that epidurals tend to slow labor down.  So, if you can get away with less medication with patient-controlled analgesia, I think it’s a wonderful thing,” said Dr. Peter Bernstein, a professor of clinical obstetrics and gynecology and women’s health at Montefiore Medical Center and Albert Einstein College of Medicine in New York City.  “And, it’s not a surprise to me that women used less anesthesia.  If you can titrate your own medication, you’re probably not going to give yourself a lot. An anesthesiologist will tend to give you a little bit more because they want to make sure there’s no pain,”

So how reliable are the findings?  The study hasn’t yet been published in a medical journal, but was presented at a medical conference by the researchers.  As a result, medical experts have not been able to look in detail at how the study was conducted or its results, making it hard to determine the reliability of the findings. This was a random controlled trial, which is the best type of study for comparing treatments.  The study was also “double blind”, in which neither the women nor their physicians knew which type of anesthesia they were being given because all participants were given buttons to push.

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