title: Epidural analgesia need not increase operative delivery rates.
abstract: OBJECTIVE
  We sought to examine the relationship between epidural analgesia and cesarean and instrumental vaginal delivery rates.
  
  
  METHODS
  This is a retrospective analysis of the first 1000 nulliparous pregnancies in women with a cephalic presentation in spontaneous labor at term in each of 3 different years, over which the epidural rate increased from 10% to 57%.
  
  
  RESULTS
  Cesarean and instrumental vaginal delivery rates were similar in all 3 years. Demographic characteristics remained unchanged or altered in a manner that has previously been associated with an increase in intervention. Electronic fetal monitoring and first-stage oxytocin use remained unchanged, but oxytocin use in the second stage increased considerably.
  
  
  CONCLUSIONS
  Increased use of epidural analgesia had no effect on cesarean delivery rates. Although randomized trials have suggested that it increases instrumental vaginal delivery rates, this might be overcome by active management of labor or judicious use of oxytocin in the second stage.
authors.affiliation: National Maternity Hospital, Dublin, Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Impey
authors.forename: K
authors.initials: K
authors.lastname: MacQuillan
authors.forename: M
authors.initials: M
authors.lastname: Robson
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D001034:Apgar Score; D001724:Birth Weight; D001827:Body Height; D001835:Body Weight; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000502:physiology*; D010121:Oxytocin / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
chemical_list: D010121:Oxytocin