EMBARGOED UNTIL: Tuesday, October 21, 1997
This news release is protected by copyright.
American Society of Anesthesiologists attribution is required.
NEW DATA DEBUNKS BELIEF THAT EPIDURALS CAUSE C-SECTIONS
ASA ANNUAL MEETING
David J. Birnbach, M.D.
Steven T. Fogel, M.D.
Stephen D. Pratt, M.D.
CONTACT:
Denise M. Jones
Philip S. Weintraub
(847) 825-5586
Oct. 18-22: (619) 525-6411
SAN DIEGO -- Four independent research studies involving a combined total of more than 22,000 women debunk the misconception that labor epidural analgesia increases a woman's risk of having a cesarean section delivery (c-section).
The results of all four recent studies challenge claims that epidural blocks interfere with labor. One of the studies suggests epidurals may even help women avoid an emergency c-section. Three of the studies were presented at the annual meeting of the American Society of Anesthesiologists(ASA). The fourth appeared in the September 1997 issue of the medical journal Anesthesiology.
The results of the four studies are being released at the ASA meeting, which this year marks the 150th anniversary of modern obstetric anesthesia. In Boston on April 7, 1847, Fanny Appleton Longfellow, the wife of poet Henry Wadsworth Longfellow, became the first known American woman to receive ether anesthesia for the birth of their daughter. Just three months earlier in Scotland on January 19, 1847, James Young Simpson, M.D., used ether to successfully anesthetize a woman with a deformed pelvis for the delivery of her baby.
The recent findings have significant implications for physicians, patients and insurers, said one of the researchers, Steven T. Fogel, M.D., an anesthesiologist at Washington University School of Medicine in St. Louis. "Some physicians and insurance companies limit patient access to epidurals because they wrongly believe that epidurals can prolong labor," Dr. Fogel said. "Delaying or withholding an epidural forces the pregnant woman to suffer needlessly and does not lower the cesarean delivery rate."
An epidural block is given in the lower back and is used to decrease sensation in the lower areas of the woman's body during labor. A small area adjacent to the mother's spine, called the epidural space, is bathed in anesthetic. Pain relief begins in about 10 to 20 minutes. Each year, about 1 million women choose epidural blocks for safe and effective pain relief during labor. A study by Dr. Fogel and colleagues at Washington University analyzed labor and delivery data on 7,000 patients. The researchers compared the c-section delivery rates among first-time mothers during the 12 months before and the 16 months after epidural analgesia became available on request at the hospital. They found no significant differences in c-section rates before and after the service's introduction.
"Since patient demographics and c-section rates did not change, we can safely and accurately conclude that the total number of c-section deliveries performed was not affected by the availability of epidural analgesia," Dr. Fogel said.
Similar findings emerged from an analysis of data on more than 13,000 first-time mothers who gave birth between 1989 and 1995 at St. Luke's-Roosevelt Hospital Center, a teaching hospital of Columbia University in New York City.
The analysis showed that the mother's age, the baby's birth weight and use of the labor-inducing drug oxytocin increased the women's risk for c-sections. "Not only was epidural analgesia not a significant risk factor, but it was associated with a slightly decreased c-section delivery risk," anesthesiologist David J. Birnbach, M.D., said.
By relieving pain, epidural analgesia may help some patients relax, and this relaxation could facilitate labor, Dr. Birnbach said. "We're not suggesting the technique will prevent c-sections," he stressed, "but in our practice, epidurals are clearly not a cause." In addition, the use of epidural analgesia almost doubled at the hospital during the five years studied (from 37 percent to 68 percent), but the percentage of c-section deliveries did not increase, Dr. Birnbach said.
A third study at Boston's Beth Israel Deaconess Medical Center reviewed the labor and delivery records of more than 2,300 women who received ultra-low dose solutions of epidural medications. The ultra-low dose epidurals allow many women's labor to proceed comfortably, Stephen D. Pratt, M.D., said. For women requiring more pain relief, additional medication can be given by the same epidural route.
The Boston study showed that women who needed additional pain relief beyond the ultra-low dose were more likely to have c-sections. Women who needed more than two additional doses were twice as likely to require a c-section as those who did not.
"Epidurals do not cause c-sections. Rather, women who have abnormal labor may be in more pain and therefore are more likely to need an epidural and stronger medication," Dr. Pratt said.
The fourth study, published in the September 1997 issue of Anesthesiology, was conducted by researchers at the University of Texas Southwestern Medical Center in Dallas. Researchers set out to "evaluate the effects of epidural analgesia on the rate of cesarean deliveries." The study of 700 women found that epidural blocks were not associated with higher rates of c-section deliveries. Copyright (c) 1997 American Society of Anesthesiologists All Rights Reserved ###
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