Epidurals and the c-section question
CMAJ 1997;157:362
© 1997 Canadian Medical Association
A Calgary anesthetist is launching a study in an attempt to determine what kind of pain relief during childbirth is best for mothers and babies. Dr. Terrance Breen, director of obstetric anesthesia at the Foothills General Hospital in Calgary, has designed a multicentre study to examine the effects of epidural and intravenous narcotic pain relief on mothers, babies and the progression of labour. The study will involve 1600 patients at centres in Calgary, Toronto, Halifax and Saskatoon.
Some recent studies have shown a link between epidural analgesia and cesarean section, but Breen feels this work suffers from "serious methodological problems." His prospective, randomized study, funded by the Alberta Heritage Foundation for Medical Research, will follow deliveries in nulliparous women who have spontaneous, active labour; it should answer the question about a connection between epidurals and cesarean-section births.
"If epidurals are a problem, we need to know they are and we need to deal with it," Breen says. "Clearly they provide the best form of pain relief, but if they cause a problem we need to form a strategy and solve it. If not, we need to lay this issue off to the side and go on to find the real problem."
The study cannot be blinded -- it would be clear to everyone involved in a delivery that a patient has chosen intravenous narcotics or an epidural. Because epidural analgesia is a superior form of pain relief, it is also impossible to deny it to patients in the intravenous-narcotics arm of the trial. And that could present a problem: if too many participants in the study cross over from intravenous narcotics by requesting an epidural, the study's results could become fouled. To avoid this, Breen and his team will monitor the number of participants crossing over. If their numbers grow too large, more participants will be recruited for the intravenous-narcotics arm.
The study will measure the effects of analgesia on progression of labour, pain relief, a newborn's first day of life, breast-feeding, fever and back pain after delivery.
"Whatever the results, they will provide the best information to women and their caregivers [and] allow everyone to make a better informed choice of different treatments." -- Richard Cairney
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