When Stanford researchers started examining national epidural rates, what jumped out at them was the unexpectedly high rates of all pregnant women who get the spinal anesthesia to relieve pain during childbirth.
The researchers were busy mining data on birth certificates from 17 million deliveries across the nation from 2009 to 2014 — intent on uncovering information on epidural rates among obese women — when they stumbled across the overall figure.
"We were blown away," said Alexander Butwick, MD, an associate professor of anesthesiology. "We were really surprised the rates were so high."
Seventy-one percent of pregnant women get epidurals or other spinal anesthesia, according to the study, which appears online in Anesthesiology. That’s an increase of 10 percent from 2008, according to the researchers.
An epidural is a nerve block delivered through a small, flexible tube, called a catheter, that goes near the spine at the small of the back. It continues to deliver medication throughout labor. The choice of whether to get an epidural in place of other anesthesia or no anesthesia at all is usually up to the pregnant mother.
Little scientific data exists on the use of epidurals in general, said Butwick, a physician-scientist who has administered epidurals and other anesthesia to hundreds, maybe thousands, of pregnant mothers during birth at Stanford.
"There's a lot of misinformation available online that is more likely to suggest epidurals may not be great," Butwick told me. "And yet, here we are. The rates have gone up, for whatever reason."
This study set out to examine the use of epidural by the nearly a quarter of women in the United States who are obese when they become pregnant.
Obese women face added risks during pregnancy such as higher rates of stillbirth, prolonged labor and the need for cesarean delivery. They are also more at risk of airway complications if a general anesthesia is needed for an unplanned c-section.
Butwick told me epidurals can help mitigate some of these risks while reducing pain levels particularly during long labors. But there is little evidence-based research available to support these claims. This study was a first step toward trying to provide more scientific evidence about epidurals to help obese women make the often difficult choice about whether and what type of anesthesia to use during birth, he says.
In this study, researchers found only a slight increase — 4.2 percent over the last 10 years — of obese women who used epidurals compared to women of average weight — a lower figure than was expected but not surprising due to the fact that overall rates of epidural use are already so high, Butwick said.
"The goal is to better inform women, in general, about the effects of epidurals during labor," Butwick said, noting that compared to other forms of pain relief such as intravenous medications or inhaled pain relief like nitrous oxide, epidurals are more effective.
Butwick and his colleagues want to "help women make the best choice for themselves," he said.
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