Does it matter at what stage a woman in labor is given epidural anesthesia?

Often, women are given the confusing advice that it is best to wait as long as possible during labor before receiving an epidural—but not too long so you don’t miss the boat at controlling the pain during delivery. A new study conducted at the Hadassah Medical Organization with nearly 19,000 women who gave birth between 2003 and 2015 reveals that, with respect to safety or length of labor, there is no significant difference at which stage of labor a women receives an epidural.

The study, the first to examine whether the timing of epidural anesthesia during labor and delivery has a significant effect, appears in the leading medical journal Acta Obstetricia et Gynecologica Scandinavica.

In Western countries, 60 percent of women opt for epidurals to reduce pain during labor and delivery. The study found that the duration of delivery did not vary significantly among women who chose to have epidurals at the beginning of labor, in the middle of labor, or closer to the end. Nor did more of these women who received epidurals require cesarean sections.

Prof. Simcha Yagel, director of Hadassah’s Division of Obstetrics and Gynecology, explains, "Epidural analgesic is the most common and effective means of relieving pain in the delivery room. Despite its widespread use, the question of its effect on the duration of the various stages of delivery remained unanswered. For years now, I have heard that there is a widespread presumption in maternity—even among physicians and midwives—that it is better for a woman to receive an epidural as late as possible, but not too late so as not to miss its effectiveness in reducing delivery pain. This uncertainty creates stress in the delivery room.”

Hadassah nurse Michal Lipschuetz, a doctoral student in computational biology at Bar Ilan University, investigated this important subject under the guidance of Prof. Yagel and Prof. Ron Unger of Bar Ilan. She relates, “In our study, we examined the duration of the birth process according to what stage in the cervical dilation an epidural was given. The timing wasn’t significant in prolonging birth, and a woman who decides mid-birth that she’d like an epidural can get it without ill effects. Likewise, if a woman has decided before starting labor that she wants an epidural, she should get it as soon as labor begins.”

Prof Simcha Yagel concludes, “Giving birth is one of life’s great moments, but it’s also painful and, for some women, very long. Epidurals can help. Now we know that a woman who wants an epidural doesn’t have to wait, and the woman who decides during birth that she wants an epidural shouldn’t be refused. A positive birth experience is important to the process of attachment to the baby and the mother's recovery, physically and emotionally.”

Prof. Yagel points out that further studies are needed to investigate the impact of epidural timing on induced or oxytocin-augmented labors.