An epidural's timing does not seem to affect cesarean rates.
THE QUESTION To ease the pain of childbirth, many women receive an epidural, a local anesthetic that is injected into the space around the spinal cord. Does the timing of this injection -- either early or later on in labor -- affect whether the delivery will be vaginal or by cesarean?
THIS STUDY randomly assigned 728 women, ready to deliver their first child with the help of an epidural, to be given the anesthetic either early in labor or later. Women in the early group were given a spinal injection of the painkiller fentanyl the first time they asked for pain relief and the epidural at the next request. The later group was given another painkiller, hydromorphone, intravenously and by injection into muscle once or twice, followed by an epidural when the cervix was dilated at least four centimeters or when the woman asked for pain relief for the third time. The rates of cesarean delivery were similar: 18 percent for the early group and 21 percent for the later group. Labor was shorter for those given an early epidural. These women also reported less pain and less severe nausea and vomiting.
WHO MAY BE AFFECTED BY THESE FINDINGS? Pregnant women.
CAVEATS Delivery methods and the use of oxytocin to stimulate labor may have differed among obstetricians and may have affected the results. The use of different pain relievers also may have affected the length of labor.
BOTTOM LINE Pregnant women may wish to talk with their obstetrician about pain relief options before labor begins.
FIND THIS STUDY Feb. 17 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.
LEARN MORE ABOUT epidurals and other childbirth pain relief options at www.mayoclinic.com(type "epidural" in search field) and www.aana.com (click "Patient Resources").
An oral solution may be as good for young children as IV fluids.
THE QUESTION Very young children can become dehydrated after a bout of diarrhea or a stomach virus. To restore water and electrolytes, might an over-the-counter solution taken orally work as well as fluids given intravenously?