Epidural analgesia for labour pain: A review of availability, current practices and influence on labour

Abstract

Summary We performed a review on the availability and current practice of epidural analgesia for labour pain and the influence of epidural analgesia on the outcome of labour. Recent surveys in North America and Europe have shown a trend towards increased labour pain management; no surveys from Africa, Asia, Australia or South America could be identified. Systemic medications remain the most common approach. In most countries, the use of epidural analgesia is steadily increasing with rates of between 14% and 38%, whereas in Hungary and two regions of Italy the epidural rate is below 5%. Twenty-four hour availability was reported more frequently at university hospitals or centres with a high delivery rate, than in smaller hospitals or rural areas. There is an increasing tendency in all countries, for epidural analgesia to be assigned to the responsibility of an anaesthetist. Recent developments, such as low concentrations of local anaesthetics and additional opioids, have become part of clinical practice in some European countries, although there is no data available from other countries, and there is no data on the use of ropivacine or sufentanil. The majority of midwives and obstetricians believe that epidural analgesia prolongs labour and 42% of midwives in the United States agreed that they should discourage its use. Current studies indicate an association between epidural analgesia and increased duration of labour, oxytocin augmentation, instrumental vaginal delivery, dystocia and Caesarean section. It remains unclear whether epidural analgesia causes abnormal labour or merely serves as a marker. Because epidural analgesia is only one of many factors influencing the course of labour, conclusions drawn from research centres may not necessarily apply to other institutions. Each individual hospital and its care providers should monitor their own statistics regarding epidural analgesia and intervention rates.