This study published in the prestigious British Medical Journal covered 567,216 births in Scotland (between 2007 and 2019), 22% of which took place with an epidural. Serious events were considered if they occurred between the date of delivery and 42 days afterward.
Severe maternal morbidity is reduced by a third with epidurals, and when combining severe maternal morbidity with the risk of intensive care admission, the risk reduction reaches 54%.
For what ? If the epidural is associated with less maternal morbidity, it is, believe the authors from the obstetrics department of the Royal Glasgow Hospital, perhaps thanks to the care associated with the epidural, which includes more careful medical monitoring, reducing stress and avoiding more aggressive anesthesia. During a cesarean section, the use of epidural analgesia can also avoid the need for spinal or general anesthesia, or allow the possibility of carrying out obstetric interventions if the need arises.
Even greater benefits for women at risk
Women with a medical indication for epidural analgesia, such as a history of cesarean section, breech baby, or twin pregnancy, even achieve a 50% reduction in severe maternal morbidity using the epidural. Similarly, those who gave birth prematurely received a 47% reduction.
Furthermore, Scottish researchers have highlighted an over-representation of black women, among whom severe maternal morbidity is four times higher than among white women. Recently, studies carried out in the United Kingdom revealed that black women are less likely to benefit from an epidural than the rest of the general population. To explain these inequalities, researchers put forward the hypothesis that these patients are sometimes more worried about the side effects of analgesia on their unborn baby, so they need to be better informed. Furthermore, they urge health authorities and doctors to encourage women in general to use epidural analgesia and, for their part, to better observe recommendations for good medical practices. “Expanding access to epidural analgesia for all women during labor, and particularly for those at greatest risk, could improve maternal health,” they write.
Nearly 83% of French women had epidural analgesia in 2021
In mainland France, according to Inserm’s national perinatal survey (results from the 2021 edition), 82.7% of women had epidural analgesia (compared to 81.4% in 2016). This high rate is in line with women’s wishes. The rate of self-administration of analgesia by PCEA type pump (electronic device equipped with a reservoir and a push button which allows the patient to control the administration of medications, in this case the product of analgesia) also saw a clear increase: 74.2% compared to 53.8% in 2016.
If the epidural has definitely convinced women in France, preconceived ideas persist. For example, a tattoo in the lower back region does not constitute a contraindication to epidural anesthesia. However, it is best for the anesthesiologist to avoid injecting directly into the tattooed area.
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Source: Destination Santé
