title: Epidural analgesia for pain relief in labour and childbirth - a review with a systematic approach.
abstract: BACKGROUND
  Clinical ambiguity concerning effects of epidural analgesia for pain relief in labour seems to reflect a need for evidence-based knowledge for midwives.
  
  
  OBJECTIVE
  This study aimed to review, with a systematic approach, the literature about effects and risks associated with the use of epidural analgesia for pain relief in labour and childbirth.
  
  
  METHODS
  A structured question was formulated and used for deriving search terms, establishing the inclusion of certain criteria and retrieving articles, i.e. what are the effects of epidural analgesia for pain relief in labour and childbirth? References were obtained through searches using MeSH-terms in Medline and Subheadings (SH) in CINAHL (e.g. Obstetrical Analgesia combined either with psychology or adverse effects and together with, Dystocia, Caesarean Section, Infant Newborn and Breastfeeding). The articles were divided into prospective randomized trials (C), non-randomized prospective studies (P) and retrospective studies (R). Scientific quality of the studies was assessed on a three-grade scale: high scientific quality (I), moderate scientific quality (II) or low scientific quality (III).
  
  
  RESULTS
  Twenty-four articles were retrieved and systematically assessed. Seven studies were judged as high quality, 15 as moderate quality and two as low quality. The majority of studies appraised in this review failed to obtain or establish a cause and effect relationship. According to the data, it seems clear that the use of epidural analgesia is considered to be an effective method of pain relief during labour and childbirth from the perspective of women giving birth.
  
  
  CONCLUSIONS
  Midwives and doctors can recommend this form of pain relief. However, information about possible associations with adverse effects in mothers and infants must be provided to expectant couples.
authors.affiliation: Obstetrics and Gynaecology, Department of Clinical Science, Umeå University, Umeå, Sweden. astrid.nystedt@nurs.umu.se
authors.forename: Astrid
authors.initials: A
authors.lastname: Nystedt
authors.forename: David
authors.initials: D
authors.lastname: Edvardsson
authors.forename: Ania
authors.initials: A
authors.lastname: Willman
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects / Q000451:nursing / Q000523:psychology / Q000592:standards; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000451:nursing / Q000523:psychology / Q000592:standards; D001294:Attitude to Health; D001942:Breast Feeding; D002585:Cesarean Section; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015337:Multicenter Studies as Topic; D009721:Nurse Midwives / Q000592:standards; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D009773:Obstetric Nursing / Q000592:standards; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D010147:Pain Measurement; D011247:Pregnancy; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012107:Research Design / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome