Epidural analgesia in labourBMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7027.379b (Published 10 February 1996) Cite this as: BMJ 1996;312:379
- Donal J Buggya
- Senior registrar in anaesthesia St Mary's Orthopaedic Hospital, Cappagh, Dublin 11, Republic of Ireland
EDITOR,—The comments on epidural analgesia for labour in Philip Steer's review overlooked important new evidence relating to postpartum backache and a potential hazard of ambulatory epidural analgesia.1
Steer implies that the use of epidurals in labour results in increased rates of long term backache. However, the reference supporting this is a retrospective review of only 39% of a population of women who delivered their baby at a given hospital over an eight year period.2 Apart from the inherent drawbacks in making causal associations in a retrospective study, recall bias over such a protracted period would tend to render its conclusions unreliable.
On the contrary, a more recent prospective study of 1042 women interviewed during their admission for delivery and again two months later found no difference in the incidence of new postpartum back pain between those who received epidural analgesia for labour (44%) and those who did not (45%).3 The design of this study is more appropriate to assess cause and effect, and the results impressively refute the suggestion that epidural analgesia is a risk factor for “long term backache.”
Furthermore, although Steer correctly states that the combined spinal-epidural technique of ambulatory labour analgesia may cause a greater degree of maternal hypotension than conventional epidural analgesia, he does not mention its potential impact on posterior column sensation, particularly proprioception.4 This may undermine safe ambulation, although there is no doubt that the ambulatory technique improves maternal satisfaction and that retention of lower limb mobility is an advance, even if actual walking may not be advisable.