title: Effect of availability of a parturient-elective regional labor pain relief service on the mode of delivery.
abstract: OBJECTIVE
  Regional analgesia for labor pain relief is effective and widely used. This study evaluated the controversial association between mode of operative delivery and patient-elective labor regional analgesia.
  
  
  METHODS
  We retrospectively compared the rates of instrumental vaginal and cesarean deliveries in parturients before the introduction, in the first 15 months after, and in the subsequent 36 months after the implementation of an elective labor regional analgesia service. A total of 9779 low-risk singleton cephalic pregnancies above 36 weeks of gestation were included. The maternal and fetal outcomes for parturients before the service was implemented and in those with or without pain relief service in the two postimplementation periods were analyzed. Multivariate logistic regression analyses were used to investigate the effects of maternal age, gestational weeks and newborn weight, in addition to regional analgesia, on the mode of delivery in nulliparous women.
  
  
  RESULTS
  After adjusting for maternal age, gestational weeks, and newborn weight, no significant association was found between regional analgesia and cesarean delivery in nulliparas. Further, this lack of association was not affected by the receipt of regional analgesia in the early period of program implementation or in the period after staff had become familiar with the service. A higher rate of instrumental vaginal delivery was noted in nulliparas given regional analgesia.
  
  
  CONCLUSIONS
  Regional analgesia for pain relief increased the likelihood of instrumental vaginal delivery, but did not increase the likelihood of cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Hsiao-Lin
authors.initials: HL
authors.lastname: Hwa
authors.forename: Li-Kuei
authors.initials: LK
authors.lastname: Chen
authors.forename: Tony Hsiu-Hsi
authors.initials: TH
authors.lastname: Chen
authors.forename: Chien-Nan
authors.initials: CN
authors.lastname: Lee
authors.forename: Ming-Kwang
authors.initials: MK
authors.lastname: Shyu
authors.forename: Jin-Chung
authors.initials: JC
authors.lastname: Shih
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D002585:Cesarean Section; D003657:Decision Making; D005113:Extraction, Obstetrical; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D012189:Retrospective Studies