Epidural Anesthesia With Low-Dose Oxytocin May Increase Cesareans
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NEW YORK (Reuters Health) Apr 04 - Epidural anesthesia during labor, plus
low-dose oxytocin treatment, which is usually used in most large North
American obstetric units, may increase the likelihood of cesarean section,
according to Canadian researchers. Most of the research has focused on the
use of high-dose oxytocin, not on the low-dose protocol.
"The bottom line," lead investigator Dr. Andrew J. Kotaska told Reuters
Health, "is that epidural analgesia gives great pain relief but...it has
undesired effects as well."
"Researchers," he added, "noticed over a decade ago that aggressive
detection of dystocia and treatment with high-dose oxytocin are required to
offset the slowing effect of epidurals on labor, but the message has not
gotten out to practicing clinicians or the public."
Dr. Kotaska and colleagues at the University of British Columbia, Vancouver
examined data from eight randomized trials involving more than 3500 women.
These trials compared opioid and epidural anesthesia. Seven of the trials
used a high-dose oxytocin protocol and none showed an increase in cesarean
section in those given epidural anesthesia, the researchers report in the
March issue of the American Journal of Obstetrics and Gynecology.
However, the remaining trial included only 93 women and employed low-dose
oxytocin, demonstrated a significant increase in cesarean section in the
epidural group. The rate in the opioid group was 2% versus 25% in the
epidural group. Because of the large difference in cesarean section rate,
the trial was stopped.
These data are limited, but "most large North American obstetric units use
low-dose oxytocin" continued Dr. Kotaska, "and women and their physicians
across North America are choosing epidural analgesia in low-dose oxytocin
settings thinking that they will not increase the likelihood of C-section."
"Our study," he concluded, "highlights that the evidence they are basing
this assumption on is not valid in most contemporary North American practice
settings. Women should certainly have access to epidural analgesia, but also
access to accurate information about its undesired effects."
Am J Obstet Gynecol 2006;194:809-814.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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