WHAT DOCTORS READ:EPIDURALS: PAIN AFTER BIRTH

Women who have had epidurals during labour and birth are more likely to experience long term problems like backache and headache.

According to a large scale study by the University of Birmingham Medical School of nearly 12,000 women who’d given birth between 1978-85, those women who’d had epidurals had about twice as much backache, and one and a half times more frequent headaches, neckaches, migraine and tingling in hands or fingers.

Women who’d undergone epidurals also had about a quarter more episodes of dizziness or fainting. Twenty three of the twenty six women who’d experienced numbness or tingling in the lower back, buttocks and leg had had epidurals.

Of the 34 women reporting spinal headache, nine reported long term headaches. Of the nine, five had had accidental spinal puncture and four a spinal block.

These results were published the same time as another report with evidence that epidural analgesia sharply reduces both the efficiency of uterine contractions and the rate of cervical dilation, resulting in an increased risk of delivery by caesarean section.

In the study, conducted by Dr. Edward R Newton of the University of Texas Health Science Center at San Antonio and reported at the annual meeting of the Society of Gynaecologic Investigation in San Antonio, Texas, 62 patients who received continuous epidural analgesia were matched with the next two patients of equal parity (ie, in number of children they’d given birth to) who did not receive an epidural.

After epidural placement, the rate of cervical dilation was 1.89 cm per hour in the epidural group, compared with 5.58 cm per hour in the controls. The overall rate of cervical dilation was also slower in the epidural group, with 2.5 cm per hour compared with 6.4 cm per hour. The second stage of labour was also about twice as long in the epidural group.

The epidural group required 2.5 times the dosage of oxytocin (a drug hurrying labour along) than did the controls.

None of the control patients required caesarean section and only two vacuum or forceps, whereas three of the women receiving epidurals had caesareans and nine, vacuum or forceps.

These results have special significance for America, where epidurals are widespread for simple pain relief. Labouring mothers in the UK tend to be more cautious, resorting to epidurals only for complex and high risk deliveries.