BY KATHRYN DOYLE
NEW YORK Thu Jun 26, 2014 2:38pm EDT
(Reuters Health) - If you were giving birth, what would be your choice: a longer labor with relatively less pain, or a shorter labor with terrible pain? That’s the question researchers posed to 40 pregnant women. Their preference? Less-intense pain, at the cost of a longer labor.
“Interestingly, intensity is the driver,” said lead author Dr. Brendan Carvalho, from the Stanford University School of Medicine in California.
Using an epidural “may prolong labor but reduces pain intensity, and it seems that would be preferable to most,” he told Reuters Health in an email.
For the study, Carvalho and his colleagues gave a seven-item questionnaire to expectant mothers who had arrived at the hospital to have labor induced but were not yet having painful contractions. The women took the survey a second time within 24 hours of giving birth.
The questionnaire pitted hypothetical pain level, on a scale of zero to 10, against hours of labor.
A sample question asked, “Would you rather have pain intensity at two out of 10 for nine hours or six out of 10 for three hours?”
Both pre- and post-labor, women on average preferred less intense pain over a longer duration, according to results published in the British Journal of Anaesthesia.
Granted, the 40 women in the study were all scheduled to have labor induced, so they may have been in for a longer labor anyway, Dr. Ruth Landau said. It might be interesting to see the results of this questionnaire given to women who are not induced, or who do not plan to have an epidural, she said.
Landau, who was not part of the study, is the director of Obstetric Anesthesiology and Clinical Genetics Research at the University of Washington Medical Center in Seattle.
Nevertheless, this may reassure women who believe they want to have an epidural that they’re making the right decision to have an early analgesic, Landau told Reuters Health.
“Obviously if we could control pain and duration, dial them both up and down based on what women wanted, we would do that,” Landau said. “But we don’t have a way to dial up or down duration of labor.”
There is some evidence that an epidural may prolong labor, but it’s not unanimous, she said.
“What we can do and should do is better inform women that we know that most women prefer low intensity of pain, particularly first-time moms,” she said.
In a way, it’s good that pain intensity seemed to be most important, since the current pain rating scale of zero to 10 focuses on intensity, Carvalho said. But doctors are limited in how they assess pain, he noted.
“Labor’s got a lot of factors to it, it’s difficult to capture in one score,” he said.
It’s also wrong to assume that women unwaveringly prefer zero pain, he said. Most women prefer a low, manageable level of pain.
“The one good thing that does happen in labor is we use patient controlled analgesia,” he said. “Women control how much medication they get, which is better than getting prescribed a set dose from start to finish.”
“More medication makes legs heavy, may make labor longer and will more likely involve forceps or vacuum (to help deliver the baby), and less medication means more intense pain and also the ability to be more active,” he said. “Women would benefit from more conversation about this.”
SOURCE: bit.ly/1nz4034 British Journal of Anaesthesia, online June 6, 2014
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