title: The effect of a rapid change in availability of epidural analgesia on the cesarean delivery rate: a meta-analysis.
abstract: OBJECTIVE
  This study was undertaken to quantitatively estimate the effect of a rapid introduction or withdrawal of on-demand epidural analgesia on the cesarean delivery rate.
  
  
  METHODS
  MEDLINE and meeting abstracts were searched for studies reporting the cesarean delivery rate immediately before and after a rapid change in the availability of epidural analgesia. Nine studies reporting data on 37,753 patients were selected. Meta-analysis was performed to estimate the means and 95% confidence intervals for the changes in rates of total cesarean deliveries, cesarean deliveries among nulliparous women, cesarean deliveries for dystocia, and operative vaginal deliveries.
  
  
  RESULTS
  There was no significant change in the overall cesarean delivery rate with an increase in the availability of epidural analgesia. Similarly, the rates of cesarean deliveries among nulliparous patients, of cesarean deliveries for dystocia, and of operative vaginal deliveries did not significantly differ between periods of high and low epidural analgesia availability.
  
  
  CONCLUSIONS
  A rapid change in the availability of epidural analgesia is not associated with any increase in the cesarean delivery rate.
authors.affiliation: Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: S
authors.initials: S
authors.lastname: Segal
authors.forename: M
authors.initials: M
authors.lastname: Su
authors.forename: P
authors.initials: P
authors.lastname: Gilbert
mesh_terms: D015360:Analgesia, Epidural; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric; D004420:Dystocia / Q000601:surgery; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D013513:Obstetric Surgical Procedures / Q000706:statistics & numerical data; D010298:Parity; D011247:Pregnancy; D013997:Time Factors; D014621:Vagina / Q000601:surgery