title: The effect of epidural anesthesia on the length of labor.
abstract: BACKGROUND
  Epidural anesthesia, although effective, has been associated with changing the course of labor. Previous studies have been criticized for not pinpointing the factors determining the use of epidural anesthesia. The purpose of this study was to determine the effect of epidural anesthesia use on the course of labor.
  
  
  METHODS
  A retrospective chart review of 224 women who gave birth from July 1, 1993, to June 30, 1994, was completed in a small-town family practice. The time frame included 6 months before and after the initiation of Tenncare, a state-funded health insurance plan designed to serve the uninsured and those previously served by Medicaid in Tennessee.
  
  
  RESULTS
  The rate of epidural anesthesia use in this study population fell sharply after January 1, 1994, the start date for Tenncare. Epidural anesthesia by women in this study was found to increase the average length of the second stage of labor by 38 minutes for primiparas and 23 minutes for multiparas.
  
  
  CONCLUSIONS
  The average length of the second stage of labor is significantly longer for women who receive epidural anesthesia. The rate of epidural anesthesia use in this study population was strongly influenced by a change in health-care financing.
authors.affiliation: East Tennessee State University, Bristol 37621.
authors.forename: S
authors.initials: S
authors.lastname: Johnson
authors.forename: J A
authors.initials: JA
authors.lastname: Rosenfeld
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000191:economics / Q000706:statistics & numerical data; D000773:Anesthesia, Obstetrical / Q000191:economics / Q000706:statistics & numerical data; D036861:Delivery, Obstetric; D005194:Family Practice / Q000191:economics; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007743:Labor, Obstetric / Q000187:drug effects*; D008484:Medicaid / Q000191:economics; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D013714:Tennessee; D013997:Time Factors; D014481:United States; D014768:Virginia