The effect of early epidural versus early intravenous analgesia use on labor progression: a natural experiment.
OBJECTIVE
The purpose of this study was to compare the effect of early epidural with the use of early intravenous analgesia on labor progression.


METHODS
We systematically selected singleton, nulliparous term pregnancies with a spontaneous labor and analgesia placement <or=4 cm who were delivered at a hospital where the rate of epidural analgesia in labor increased from 1% (before) to 84% (after) in 1 year (a natural experiment). In the before period (n=223 pregnancies), 98% of women used intravenous analgesia, and 2% of women used epidural analgesia. In the after period (n=278 pregnancies), 92% of women used epidural analgesia, and 8% of women used intravenous analgesia. The median duration of labor by each centimeter of cervical dilation was computed and used as a measurement of labor progression.


RESULTS
After adjustment had been made for confounders, women in the after period had a slower labor progression only from 4 to 5 cm, compared with those women in the before period. Interestingly, the process of labor admission and epidural analgesia placement, rather than analgesia use per se, appeared to explain most of the slowdown. No significant difference in the rest of the active phase was observed between the 2 groups.


CONCLUSIONS
Our data support recent American College of Obstetricians and Gynecologists guidelines that the restraining use of epidural analgesia at <4 cm of cervical dilation is unnecessary.
Vahratian
Anjel
A
Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
Zhang
Jun
J
Hasling
Jill
J
Troendle
James F
JF
Klebanoff
Mark A
MA
Thorp
John M
JM
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007747:Labor Stage, First; D009772:Obstetrical Forceps; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors
D000700:Analgesics