From BMJ this week:
Epidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief.
My partner delivered a baby this week and struggled with 2nd stage so much that she ended up cutting an episiotomy and applying a vacuum and a consequence was a 4th degree tear. Last month, I cut the 2nd episiotomy of my lifetime and we had to fix a 3rd degree tear (one of only a handful I've been involved with). Common theme? Epidural analgesia.
I struggle with this often. On one hand .. epidurals are wonderful adjuncts to the care that we can provide to women in labor. The expoerience can be transformed from a lengthy, horrible experience to uncomfortable and tolerable. Yes, yes .. I'll never know. I will never have a baby and so .. my perspective is inherently different from those who have HAD the experience. My life with back pain has certainly made me more sensitive to my patients with back pain .. and perhaps I would not be so hesitant to embrace universal epidurals if I had really experience the pains of labor.
Yet here we are. Epidurals can enhance the likelihood of instrumental delivery and therefore complications. Like most things in medicine .. there is not an easy answer here. We need to make careful, thoughtful decisions.
Doesn’t a lot depend on the timing? I mean, if the epidural is administered too early in the second stage it could really slow down the contractions. But with experience (both of the OB and of the anesthesiologist) comes finesse in knowing just when to do the epidural. Then there isn’t as much risk of a difficult forceps delivery with tearing.