Epidurals and C-Sections

You may have seen articles in the news about the New England Journal of Medicine study on the connection between epidurals given early in labor and the risk of C-section. Many extremely misleading headlines have proclaimed "Epidurals do not raise risk of C-section", "Early epidurals do not increase risk of Cesarean delivery" and the worst: "Epidurals Safe Even if Given Early in Labor."

Just a minute.

The study cited did not study unmedicated birth at all. It only compared giving epidurals early in labor vs. systemic drugs (i.v. narcotics). Therefore, the only conclusion that can be made from the data is that early epidurals are not more likely to result in c-sections compared to i.v. pain meds. There is a connection between epidurals and increased c-section rates (a 1996 study found that "women receiving epidural analgesia were 3.7 times more likely to undergo a cesarean"). However the jury is still out on whether connection indicates causality (a long, hard labor is more likely to end in a c-section, and a woman going through such a labor is also more likely to request and receive an epidural).

Epidurals were also found to result in shorter labors compared to narcotics which by their very nature slow everything down. Even anaesthsiologists admit that "epidural analgesia has long been shown to be associated with a longer second stage of labor."

And epidurals are certainly not without risks. These include: headache, back pain (sometimes chronic), fever (mom and/or baby), fetal distress, nerve damage, increase in assisted deliveries (i.e. forceps), possible newborn feeding problems; and very rarely, epidural abscess or meningitis and paralysis.