Impact of labour epidural analgesia on mode of delivery

Abstract

Our object was to compare operative vaginal and abdominal rates before and after on demand analgesia became available in our hospital. We compared retrospectively women delivered in 1995 before introduction of on demand epidural to women delivered in 1999 after introduction of this service. The epidural rate increased from 16% (1995) to 34.5% (1999), P < 0.001. In 1995, 1371 women with singleton cephalic pregnancies at term gave birth compared to 1388 in 1999. There was no difference in maternal age, gestational age at delivery and birth weight of babies. In the 2 years there was no statistical difference in overall instrumental delivery rate (15.4% vs. 16%), non-elective caesarean rate (6.3% vs. 7.1%) and overall section rate (14.1% vs. 15%). Subgroup analysis showed an increase in non-elective caesarean rate for primiparous women from 9% to 12.1% (P = 0.14). Women who required epidural had a statistically significant higher instrumental delivery rate than women who did not. In 1995 the rate of vaginal instrumental delivery in primipara was 63.4% with epidural and 16.6% in those without. Similar results were found in 1999 (40.1% vs. 13.8%). Comparison in multipara with or without epidural demonstrated statistically significant differences in rate of operative vaginal delivery (41.7% vs. 3.4% in 1995/27.9% vs. 2.9% in 1999).