The impact of neuraxial analgesia on the progress and outcome of labor

Abstract

Epidural analgesia is an extremely popular form of labor pain relief. This popularity has led to careful examination of the effects of epidural analgesia on labor progress and outcome. Given the current widespread use of epidural labor analgesia, relatively small effects on the progress and outcome of labor could have major public health consequences. Factors that produce dysfunctional labor increase labor pain. Retrospective studies show an association between the use of epidural analgesia and cesarean section. However, the highest quality evidence, randomized trials and impact studies, find no effect of epidural analgesia on the cesarean delivery rate. Epidural analgesia may influence the incidence of operative vaginal delivery. Epidural group patients in randomized trials have longer second-stage labors and receive more oxytocin than parenteral opioid group patients. First-stage labor tends to be longer in epidural group patients but the difference is not statistically significant. Theories for these labor speed differences abound. For unknown reasons, maternal hyperthermia is more common in epidural than in opioid group patients. Epidural analgesia has no negative impact on the delivery room condition of the neonate. Patients receiving epidural analgesia report better pain relief and more satisfaction than patients receiving opioid labor analgesia. Epidural analgesia may slow labor speed but has minimal effect on labor outcome.