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Self-Administered Epidurals?

The epidural as we know it is pretty much an all or nothing experience.  The infusion of drugs is administered and controlled by an anesthesiologist, and generally consists of a fairly constant influx of pain relievers and narcotics through a tube installed in the spinal cord. There are times when the level of medication will be adjusted at the indication of the attending physician. But women themselves rarely have any control over the level of medication they receive. And they don’t always have much control over when they receive it, either—it’s not unheard of for a woman to be pressured into getting a high dose epidural relatively early in labor, just in case the anesthesiologist isn’t available once the going gets really rough. This can leave them unable to move around for the remainder of the birth process.

A new study tried out a different birth pain relief tactic:  letting the women decide how much pain relief they needed, and letting them administer the medication themselves.

The study involved 270 birthing women in Long Beach California. The initial process remained the same, but once the epidural was in place, half of the women were allowed to control the amount of medication they received throughout the birth.The study found that the women who were able to control their pain medication used 30% less medication than the ones with a traditionally administered constant epidural.

This self-monitoring and delivery of drugs is not new in the hospital setting. Patients are commonly given control over their pain relief after surgery or in recovery from injury. But in childbirth, pain relief is generally a top down phenomenon. At least in America—other countries allow women to self-administer nitrous oxide for labor pain relief, for example.  Studies show pretty much across the board that when people have control over their pain medication, they use less than they would if they don’t have control, but feel equally soothed. According to the author of the study, both sets of women were satisfied with their level of pain relief, even though the actual medication amount was lower. I can think of a few reasons for this.

One: When it comes to pain relief during childbirth,  more is not necessarily more. A too-high dose of drugs can leave moms feeling incapacitated, even paralyzed. This can create anxiety, which is counterproductive to the birthing process. And other irritating side effects are less likely to be a problem with a lower dose of drugs.

Two: A lower dose of drugs makes it more likely that a woman would be able to shift her body weight, move around somewhat, and feel more physically connected to what’s going on throughout the birth. More physical control and a greater range of motion can help with pain relief, positioning, and getting that baby out.

Three: Control inspires confidence, and confidence can make a huge difference during childbirth.  Just having the power to give themselves relief ( instead of being at the mercy of a not-always-available doctor) could factor into a woman’s sense of satisfaction with her birth experience, pain relief included.

Less meds with the same level of relief? What’s not to like here? A lower dose of medication with adequate pain management would benefit both moms and babies. I find this study so exciting because it opens up new possibilities for women as active participants, not just passive patients, in hospital births. It’s ideas like these that may help us progress toward a hospital birth model that takes into account the needs of both babies and the mothers who give birth to them.

[via netdoctor UK]

photo: Pat David/flickr

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