Epidural how many cm

Once in place, the epidural needle is replaced with a small catheter tube that can administer more medication as needed. Many women fear epidurals will make them drowsy or foggy during delivery, but mothers-to-be are fully awake and aware during the labor. However, there are some side effects that mothers may experience:.

Typically, you can receive an epidural as early as when you are 4 to 5 centimeters dilated and in active labor. Normally, it takes about 15 minutes to place the epidural catheter and for the pain to start subsiding and another 20 minutes to go into full effect. There are a lot of stories about women being too far along to get an epidural, but this is a myth. You can get an epidural any time you want. The local numbing agent alleviates most of the pain you may feel during the epidural.

Most women feel pressure and a stinging sensation as the epidural medication is injected through the needle. It was thought that if an epidural was placed before 4 centimeters dilated, it would cause a woman to need a C-section for delivery. Recent randomized studies over the past few years have not found the epidural to be correlated with the mother needing a C-section.

These studies were so profound that it encouraged The American College of Obstetricians and Gynecologists ACOG to change their guidelines in to reflect these findings. If labor does slow down after your epidural, you may be given Pitocin , a synthetic version of oxytocin which is a natural hormone that helps your uterus contract during labor.

In July Babies very long and stressful labor. Around am Monday I began to feel contractions. As time went on they got closer and stronger so I called my mom. I told myself I was going to the hospital until my water broke. Fast forward to Monday afternoon I spent most of the day in Latest: 3 months ago calFTMommy. Just curious about other people's experiences and honestly, I'm looking for validation that I did what I was supposed to and that my mixed-up emotions here are normal.

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Note that once you confirm, this action cannot be undone. Delete Comment? Are you sure you want to delete your comment? Please specify a reason for deleting this reply from the community. Overlap between early and late groups must have been even greater in Chestnut et al.

As before, dilation was measured in 0. Based on my analysis, I would argue that there was no clinically meaningful difference in dilation between early and late groups in either trial. A second pair of trials, one a mixed trial of spontaneous labor onset and induction and the other all induced, also had the same design in both trials Wong ; Wong All women were less than 4 cm dilated at first request for pain medication.

In the early group, women had an opioid injected intrathecally, i. At the second request, an epidural was initiated. In the late group, women were given a systemic opioid. At second request, they were given a second dose of systemic opioid if they hadn't reached 4 cm dilation and an epidural if they had dilated to 4 cm or more. At third request, they were given an epidural regardless of dilation.

Women who had no vaginal exam at second request and were given an epidural were 'assumed,' in the authors' words, to be dilated to at least 4 cm. What were the results? Wong included women, some beginning labor spontaneously and some induced. You may already have noticed the flaw in the trials' design: Wong and colleagues confused the issue by considering intrathecal opioid to be equivalent to epidural anesthetic in the early group, although women didn't actually receive anesthetic until their second request for pain medication some unknown time later.

So far as I know we have no evidence that opiods, spinal or epidural, have any effect on labor progress. Wong , a study of induced women, was set up the same way but reported data somewhat differently. Early-group women were administered a spinal opioid at a median of 2 cm dilation and an interquartile range of 1.

We have no information on dilation at the time they received their epidural. As with the Chestnut trials, dilation at time of epidural initiation in the two Wong trials must have overlapped considerably between groups. And, again, few women in the late epidural group would have been in active labor. The Wong trials, however, muddy the waters even further by considering spinal opioid to be the same thing as epidural anesthetic, and while the authors were careful to use the term 'neuraxial analgesia,' the Cochrane reviewers made no such distinction.

This brings us to Parameswara , a trial of women that included both spontaneous onset and induced labors. This trial defined the early group as women less than 2 cm dilated at time of epidural initiation and the late group as women more than 2 cm dilated. That's all the information they provide on group allocation. Last of the six, we have Wang , a trial of 60 women in spontaneous labor. All women were given intrathecal anesthetic plus opioid.

The early group was started on epidural anesthetic plus opioid 20 minutes later whereas the late group had their epidural initiated when they requested additional pain relief. No information is given on dilation at time of epidural initiation. Not only do we have no idea whether early and late groups differed from one another, women in both groups received neuraxial anesthetic at the same time.

In summary, 'garbage in, garbage out. The other three studies are a different story. They achieve a reasonable separation between groups. Luxman studied 60 women with spontaneous labor onset. The early group had a mean, i. Ohel studied a mixed spontaneous onset and induced group of women. The mean dilation at initiation in the early group was 2. Wang , the behemoth of the trials, included 12, women who began labor spontaneously. The early epidural group had a median dilation of 1.

Cesarean and instrumental delivery rates were similar between early and late groups in all three trials, so had reviewers included only these three trials, they would still have arrived at the same conclusion: early epidural initiation doesn't increase likelihood of cesarean and instrumental delivery. The Wang trial, as did all of the trials, limited participants to healthy first-time mothers with no factors that would predispose them to need a cesarean.

The Wang trial further excluded women who didn't begin labor spontaneously. Comparing the trials side-by-side reveals wildly varying cesarean and instrumental vaginal delivery rates in what are essentially homogeneous populations.

Comparing the trials uncovers that epidural timing doesn't matter because any effect will be swamped by the much stronger effect of practice variation. Analysis of the trials teaches us two lessons: First, systematic reviews can't always be taken at face value because results depend on the beliefs and biases that the reviewers bring to the table. In this case, they blinded reviewers from seeing that two-thirds of the trials they included weren't measuring two groups of women, one in early- and one in active-phase labor.

Second, practice variation can be an unacknowledged and potent confounding factor for any outcome that depends on care provider judgment. So what's our take home? Women need to know that with a judicious care provider who strives for spontaneous vaginal birth whenever possible, early epidural administration won't increase odds of cesarean or instrumental delivery.

With an injudicious one, late initiation won't decrease them. That being said, there are other reasons to delay an epidural. Maternal fever is associated with epidural duration. Running a fever in a slowly progressing labor could tip the balance toward cesarean delivery as well as have consequences for the baby such as keeping the baby in the nursery for observation, testing for infection, or administering prophylactic IV antibiotics.

Then too, a woman just might find she can do very well without one. Epidurals can have adverse effects, some of them serious. Comfort measures, cognitive strategies, and all around good emotionally and physically supportive care don't.

Hospitals, therefore, should make available and encourage use of a wide range of non-pharmacologic alternatives and refrain from routine practices that increase discomfort and hinder women from making use of them. Only then can women truly make a free choice about whether and when to have an epidural. After reading Henci's review and the study, what information do you feel is important for women to be aware of regarding epidural use in labor?

What will you say when asked about the study and timing of an epidural? Caughey, A. Safe prevention of the primary cesarean delivery. American journal of obstetrics and gynecology , 3 , Chestnut, D. Does early administration of epidural analgesia affect obstetric outcome in nulliparous women who are in spontaneous labor? Anesthesiology, 80 6 ,