How epidurals affect labor
A recent study done from the University of California San Francisco (UCSF) shed some interesting light on how epidurals may impact the amount of time you’ll spend pushing your baby out. Even though we already knew that epidurals do prolong the pushing part of labor (known as the second stage), this study shows it may be longer than we previously thought. The study also showed that women without epidurals also take longer to push than what was previously considered normal.
The large study looked at approximately 42,000 women who delivered at UCSF between 1976 and 2008. About half of the women had epidurals. What they found was striking: for women who had epidurals and were having their first baby, their second stage could last as long as 5.6 hours versus first-time moms without epidurals, who pushed an average of 3.3 hours. Women who already had given birth and were pushing with an epidural could take as long as 4.25 hours versus 1.35 hours without.
You might wonder why these average times matter. One of the main reasons women undergo their first Cesarean section in the United States is for prolongation or arrest of the second stage (meaning mom was pushing but the baby could not deliver, or she was not progressing fast enough). In fact, this accounts for 10-25 percent of all C-sections in the US.
Current guidelines from the American Congress of Obstetricians and Gynecologists (ACOG) state that first-time moms should deliver within 2 or 3 hours of pushing (with or without an epidural) and moms who’ve had babies before should take 1 or 2 hours (with or without an epidural). Based on this newest study, these timeframes are much shorter than they should be, leading to a possible overutilization of C-sections.
Although ACOG is still maintaining these guidelines, there has been some movement toward allowing longer stage two labor. In 2012, an ACOG working group suggested giving more time in the second stage of labor before recommending a C-section. The group recommended adding an additional hour to each category. Some practitioners have already put this into practice.
Lastly, it is important to note that longer time spent in labor is not risk-free. Moms are at higher risk for postpartum hemorrhage, need for forceps/vacuum delivery, worse vaginal lacerations with subsequent issues of urinary and fecal incontinence, and infection. Babies are also at higher risk for minor birth trauma.
So what does this all mean? Overall, the old labor curves we’ve been using to monitor labor progress are outdated and likely not applicable to our current obstetric population in the US. While epidurals do increase the length of time needed to push, many moms and babies will do well even with the longer times, and we can probably decrease our C-section rate without too many additional complications. However, it is important to always take into account the whole clinical picture, and be sure to make an informed decision with your midwife or doctor.
Takeaways
- A new study looking at 42,000 women has showed that time needed to push in labor is longer than previously expected, both for women with and without epidurals.
- A mom having her first baby can push for up to 5.6 hours if she has an epidural.
- Longer time spent in labor can lead to an increase in certain complications, so this must be weighed against the risks of a C-section.
I was told and am finding this to be more and more true that my labor (with an epidural) was out of the norm in that I pushed for less than 10 minutes. I often feel quick to argue epidurals slowing labor but the more I research the more clear it is that they do in fact slow labor. I am grateful that my labor & delivery progressed quickly. Every pregnancy, labor, and delivery is different. We’ll see how it goes that second time around. 🙂
Yes that’s true, every pregnancy is different and you were lucky to have such a fast labor! Isn’t that great?!
I had an epidural and pushed for an hour. And I thought that was long! I feel for the women pushing for 5 or 6 hours. OUCH!!!
With my first child I had an epidural and I only pushed for twenty minutes. With my second, I had to have a C-section due to the size of her and after reading this study I wish I would have been able to have her vaginally so I could have had something to compare my first to. I agree with the statement that, “Overall, the old labor curves we’ve been using to monitor labor progress are outdated and likely not applicable to our current obstetric population in the US.” I think it’s time to begin some new studies to determine some of the effects of epidurals during labor.