First-time mothers, obese women, and women who have longer labors are at higher risk for pain

According to a study presented at ANESTHESIOLOGY 2011 in Chicago, first-time mothers, obese women, and women who have longer labors are at higher risk for pain than other laboring women. Such information could be crucial in helping anesthesiologists determine how best to provide pain care with epidurals and other methods.

Because so many factors influence labor pain, leader study author Nitin K. Sekhri, M.D., from Columbia University Medical Center, sought to utilize a mathematical model that could quantify all these variables, leading to sound data for use in individualized pain treatments.

With the help of researchers from Columbia University College of Physicians and Surgeons, the Sharp Mary Birch Hospital in San Diego, and the University of California, San Francisco, Dr. Sekhri and his colleagues interviewed 800 laboring women and gathered information on ethnicity, age, weight, height, how many times they had previously given birth, whether labor was being induced, how many weeks the woman was pregnant, and the babies' weight.

Finally, pain scores were recorded every hour until the woman reached full cervical dilation.

"Most women who receive epidural catheters are comfortable during labor, but in some cases the epidural catheter does not help the woman with her pain or helps only slightly," said Dr. Sekhri. "There were several women who still continued to have significant pain even after placement of the epidural."

Epidurals, which are carefully placed next to the spinal cord, allow anesthesiologists to drastically reduce the amount of medications used in laboring women, especially compared to oral or intravenous drug administration.

Dr. Sekhri and his group found that women under 25 reported higher pain scores even after placement of an epidural. They speculated that younger women may have weaker social support systems and fewer coping mechanisms for dealing with pain.

Obese women in the study reported greater pain after epidural placement than women with a normal body mass index. This difference might be explained by the fact that epidurals are sometimes more difficult to place in obese women and that catheter tubes more easily shift in the obese, causing improper delivery of medication.

"Understanding that younger women, obese women, and women who have longer labors are at risk of pain even after placement of an epidural can help doctors and nurses identify susceptible patients," said Dr. Sekhri. "This allows the team taking care of the patient to be more attentive to these at-risk patients, and thus possibly intervening sooner.

Source American Society of Anesthesiologists