Epidural analgesia

Abstract

To the Editors:We read with interest the recent article of Impey et al (Impey L, MacQuillan K, Robson M. Epidural analgesia need not increase operative delivery rates. Am J Obstet Gynecol 2000;182:358-63) on the effect of epidural analgesia on the instrumental vaginal delivery rate at the National Maternity Hospital in Dublin. We concur with their conclusions.At Hull Maternity Hospital, Hull, United Kingdom, our management of the second stage of labor has remained the same since 1987. We allow the head to descend passively, delay pushing until the head is visible, place no strict limit on the duration of the second stage of labor, have a policy of liberal use of oxytocin during the second stage of labor, use continuous fetal monitoring, and have medical input on request.We thus offer further evidence, although retrospective in nature, that epidural analgesia need not increase the instrumental vaginal delivery rate. An increase in the cesarean section rate has been a feature of the mid to late 1990s in the United Kingdom, and we would be interested to see whether a similar trend has been apparent at the National Maternity Hospital in Dublin.6/8/109867 To the Editors:We read with interest the recent article of Impey et al (Impey L, MacQuillan K, Robson M. Epidural analgesia need not increase operative delivery rates. Am J Obstet Gynecol 2000;182:358-63) on the effect of epidural analgesia on the instrumental vaginal delivery rate at the National Maternity Hospital in Dublin. We concur with their conclusions.At Hull Maternity Hospital, Hull, United Kingdom, our management of the second stage of labor has remained the same since 1987. We allow the head to descend passively, delay pushing until the head is visible, place no strict limit on the duration of the second stage of labor, have a policy of liberal use of oxytocin during the second stage of labor, use continuous fetal monitoring, and have medical input on request.We thus offer further evidence, although retrospective in nature, that epidural analgesia need not increase the instrumental vaginal delivery rate. An increase in the cesarean section rate has been a feature of the mid to late 1990s in the United Kingdom, and we would be interested to see whether a similar trend has been apparent at the National Maternity Hospital in Dublin.6/8/109867 We read with interest the recent article of Impey et al (Impey L, MacQuillan K, Robson M. Epidural analgesia need not increase operative delivery rates. Am J Obstet Gynecol 2000;182:358-63) on the effect of epidural analgesia on the instrumental vaginal delivery rate at the National Maternity Hospital in Dublin. We concur with their conclusions. At Hull Maternity Hospital, Hull, United Kingdom, our management of the second stage of labor has remained the same since 1987. We allow the head to descend passively, delay pushing until the head is visible, place no strict limit on the duration of the second stage of labor, have a policy of liberal use of oxytocin during the second stage of labor, use continuous fetal monitoring, and have medical input on request. We thus offer further evidence, although retrospective in nature, that epidural analgesia need not increase the instrumental vaginal delivery rate. An increase in the cesarean section rate has been a feature of the mid to late 1990s in the United Kingdom, and we would be interested to see whether a similar trend has been apparent at the National Maternity Hospital in Dublin. 6/8/109867