title: Does epidural analgesia prolong labor and increase risk of cesarean delivery? A natural experiment.
abstract: OBJECTIVE
  More than 50% of pregnant women in the United States are using epidural analgesia for labor pain. However, whether epidural analgesia prolongs labor and increases the risk of cesarean delivery remains controversial.
  
  
  METHODS
  We examined this question in a community-based, tertiary military medical center where the rate of continuous epidural analgesia in labor increased from 1% to 84% in a 1-year period while other conditions remained unchanged-a natural experiment. We systematically selected 507 and 581 singleton, nulliparous, term pregnancies with spontaneous onset of labor and vertex presentation from the respective times before and after the times that epidural analgesia was available on request during labor. We compared duration of labor, rate of cesarean delivery, instrumental delivery, and oxytocin use between these two groups.
  
  
  RESULTS
  Despite a rapid and dramatic increase in epidural analgesia during labor (from 1% to 84% in 1 year), rates of cesarean delivery overall and for dystocia remained the same (for overall cesarean delivery: adjusted relative risk, 0.8; 95% confidence interval, 0.6-1.2; for dystocia: adjusted relative risk, 1.0; 95% confidence interval, 0.7-1.6). Overall instrumental delivery did not increase (adjusted relative risk, 1.0; 95% confidence interval, 0.8-1.4), nor did the duration of the first stage and the active phase of labor (multivariate analysis; P >.1). However, the second stage of labor was significantly longer by about 25 minutes (P <.001).
  
  
  CONCLUSIONS
  Epidural analgesia during labor does not increase the risk of cesarean delivery, nor does it necessarily increase oxytocin use or instrumental delivery caused by dystocia. The duration of the active phase of labor appears unchanged, but the second stage of labor is likely prolonged. (Am J Obstet Gynecol 2001;185:128-34).
authors.affiliation: Epidemiology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Building6100, Bethesda, MD 20892, USA.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: M K
authors.initials: MK
authors.lastname: Yancey
authors.forename: M A
authors.initials: MA
authors.lastname: Klebanoff
authors.forename: J
authors.initials: J
authors.lastname: Schwarz
authors.forename: D
authors.initials: D
authors.lastname: Schweitzer
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D001835:Body Weight; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008423:Maternal Age; D009772:Obstetrical Forceps; D010298:Parity; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors; D014620:Vacuum Extraction, Obstetrical