Does Epidural Analgesia Prolong Labor and Increase the Incidence of Instrumental or Operative Delivery?

Abstract

The potential effects of epidural analgesia on the progress of labor and the incidence of operative or instrumental delivery has been a subject of lasting controversy, particularly between obstetricians and anesthesiologists. This controversy is difficult to resolve, since it is almost impossible to devise fully randomized, prospective studies comparing different modes of pain relief during the first stage of labor. There is no lack of retrospective reviews. Most of them indicate that epidural analgesia is associated with longer labors and/or an increased incidence of forceps delivery or cesarean section (1–7). Similar results were reported in a few nonrandomized prospective studies (8–11), particularly when epidural analgesia was started as early as in the latent phase of labor (9). Most authors tend to see a causal relationship even though, without randomization, selection bias cannot be ruled out. Women having a painful and protracted labor (malpresentation, dystocia) are more likely to request epidural analgesia than the less affected “controls.” The same patients are also more likely to require an operative or instrumental delivery. Further, obstetricians are more prone to shorten the second stage of labor with the use of forceps or vacuum extractor when epidural analgesia is present. There are several reports indicating that epidural analgesia has no adverse effects on the progress of labor or the woman’s ability to deliver vaginally (12–17). Particularly instructive among them are the studies showing that introduction of an “on demand” epidural service did not increase the primary cesarean section rate (14–17).KeywordsObstet GynecolEpidural AnalgesiaCervical DilatationInstrumental DeliveryForceps DeliveryThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.