Timing of epidural is up to the mother

When a woman is in labour, the appropriate time to give an epidural during childbirth is when she asks for it, a new study suggests. Published in The Cochrane Library, the systematic review compared early and late epidurals during labour and found that they had very similar effects.

An epidural is a pain relieving local anaesthetic that is given as an injection into the spine. It is commonly offered to women in labour who request pain relief and is effective in reducing pain. However, previous studies have suggested that the timing of an epidural can prolong the duration of labour as well as increase the chances of needing a Caesarean section. With this in mind, Cochrane researchers collected the best available evidence on early and late epidurals and compared their effects.

“The right time to give the epidural is when the woman requests pain relief,” said lead researcher Dr Ban Leong Sng, who is also the Deputy Head and Senior Consultant of the Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital (KKH), Singapore. “If they request an epidural early during their labour, the evidence we have does not provide a compelling reason why this should be refused.”


The Cochrane researchers reviewed data from nine studies involving 15,752 first-time mothers who were randomly assigned to “early” or “late” groups. During labour, those in the early group were given epidurals when they were less than four to five centimetres dilated, while those in the late group waited until they were four to five centimetres or more dilated. When the results were analysed, those who had early epidurals were no more or less likely to need a Caesarean section than those who had late epidurals. Earlier epidurals made no difference to the likelihood of needing an assisted birth involving forceps or suction, or to the amount of time spent in the second, ‘pushing’ stage of labour. For other aspects that were measured, early and late epidural also had similar effects.

Although the researchers found no effect of early epidural on the length of time spent in the pushing stage, they were unable to reach firm conclusions about effects on the time to reach full cervical dilation. “We can’t rule out the possibility that starting epidural pain relief earlier may lead to shorter labour,” said Sng. “This is because there was a lot of variation in the results of the studies we looked at in terms of the length of the first stage of labour.”

This review is jointly carried out in collaboration with researchers from KKH, Duke-NUS Graduate Medical School, Singapore Clinical Research Institute and a medical student from NUS Yong Loo Lin School of Medicine, Singapore.

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Full citation: Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, Chan ESY, Sia AT. Early versus late initiation of epidural analgesia for labour. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD007238. DOI: 10.1002/14651858.CD007238.pub2.
URL Upon publication: http://doi.wiley.com/10.1002/14651858.CD007238.pub2

Interviews: To arrange an interview with the author, please contact Angeline Chen, Senior Executive, Corporate Communications, KK Women’s and Children’s Hospital, Singapore, at +65 6394-2321 or [email protected].

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