Neuraxial analgesia: a review of its effects on the outcome and duration of labor
OBJECTIVE We sought to examine the relationship between epidural analgesia and cesarean and instrumental vaginal delivery rates. STUDY DESIGN This is a retrospective analysis of the first 1000 nulliparous pregnancies in women with a cephalic presentation in spontaneous labor at term in each of 3 different years, over which the epidural rate increased from 10% to 57%. RESULTS Cesarean and instrumental vaginal delivery rates were similar in all 3 years. Demographic characteristics remained unchanged or altered in a manner that has previously been associated with an increase in intervention. Electronic fetal monitoring and first-stage oxytocin use remained unchanged, but oxytocin use in the second stage increased considerably. CONCLUSIONS Increased use of epidural analgesia had no effect on cesarean delivery rates. Although randomized trials have suggested that it increases instrumental vaginal delivery rates, this might be overcome by active management of labor or judicious use of oxytocin in the second stage.