A-ha!

I saw a headline in the Boston Herald today that read "Numbing News: Early Epidural Not Too Risky." The article goes on to say that a study published in the New England Journal of Medicine "found that giving a low-dose epidural early in labor won't increase the risk of a Caesarean section and may shorten labor."

Really?

You can read the full text of the study here and an abstract here.

The study was comparing early pain relief (before 4 cm dilation) in the form of intrathecal injection of fentanyl against systemic hydromorphone (epidural). It was NOT comparing epidural against NO epidural.

Moreover, in the abstract, the study found that although there was no significant difference in Cesarean rates between the two groups (intrathecal or epidural), there were these significant differences:

• The median time from the initiation of analgesia to complete dilatation was significantly shorter after intrathecal analgesia than after systemic analgesia (295 minutes vs. 385 minutes, P<0.001)
• The median time to vaginal delivery was significantly shorter after intrathecal analgesia than after systemic analgesia (398 minutes vs. 479 minutes, P<0.001)
• Pain scores after the first intervention were significantly lower after intrathecal analgesia than after systemic analgesia (2 vs. 6 on a 0-to-10 scale, P<0.001)

Most importantly:

• The incidence of one-minute Apgar scores below 7 was significantly higher after systemic analgesia (24.0 percent vs. 16.7 percent, P=0.01).

Correct me if I'm wrong, but what I interpret this article to say is that although there is no significant difference in Cesarean rates between women with early injection pain relief or early epidural pain relief, there IS a bias in the immediacy and degree of relief, in the time to complete dilation and to delivery, AND in the baby's first health assessment...ALL AGAINST THE EPIDURAL!

The Boston Herald article says the study's findings "could lead to hundreds of thousands more early epidurals in mothers-to-be each year." Great! That's 7,300 more babies with Apgar scores below 7 than if the mothers had had intrathecal injections (and how many more than if the mothers had been supported in an effort to birth without pain relief?).