Epidural analgesia as a risk factor for operative delivery.
OBJECTIVE
To study the relationship between epidural analgesia and instrumental and non-elective cesarean delivery in the 1990s in Finland.


METHODS
The data was extracted from a nationwide birth register in 1991-1993. To adjust for other factors, hospital-based analyses were made separately for different types of hospitals and in individual-based analyses logistic regression was used.


RESULTS
In the hospital-based analyses there was no systematic correlation between rates of epidural analgesia and operative delivery, but on the individual level there was. Comparison of hospitals with different levels of epidural rates and different types of hospitals suggests that the contradictory findings in the hospital and individual-based analyses are partly due to selection bias, and partly to different hospital policies.


CONCLUSIONS
The results in previous studies and our results suggest that epidural analgesia is a risk factor for an operative delivery, but not a sufficient one, and its impact is likely to be modified by other obstetric practices and interventions.
Hemminki
E
E
National Research and Development Centre for Welfare and Health, Health Services Research Unit, Helsinki, Finland.
Gissler
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M
D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D006801:Humans; D016015:Logistic Models; D010298:Parity; D011247:Pregnancy; D012307:Risk Factors