title: Epidural anaesthesia for labour: does it influence the mode of delivery?
abstract: BACKGROUND
  Epidural anaesthesia (EDA) is an effective method to lower labour pain. EDA might have an impact on instrumental delivery rates and on caesarean section rates. The present study compares the mode of delivery in women who were either receiving EDA or not. The indication for EDA was pain relief only in order to switch off a selection bias.
  
  
  METHODS
  During a 1-year duration, we included a total of 1,452 cases. Exclusion criteria were factors that could influence the mode of delivery, independent from EDA, as well as obstetrical indications for administering EDA. 530 women remained in the analysis. The primary outcome variable was the mode of delivery.
  
  
  RESULTS
  We detected in both nullipara and multipara a statistically significant accumulatin in patients with EDA and caesarean section combined. Most importantly, the majority of the women without EDA (57% of nullipara and 60% of multipara) delivered within the median timeframe from admission until administration of EDA.
  
  
  CONCLUSIONS
  It seems to be obvious to conclude that EDA as performed in our study results in a higher rate of caesarean sections. It is important though to take into consideration that between the period from admission to the delivery ward and administration of EDA most of the parturients without EDA had already delivered. Our results make evident, that the administration of EDA exclusively used for reducing labour pain is a result of a complex collaboration of temporal conditions of labour as well as psychological conditions and also of the mother's wish.
authors.affiliation: Department of Anaesthesiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. Andrea.Ros@t-online.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Ros
authors.forename: Ricardo
authors.initials: R
authors.lastname: Felberbaum
authors.forename: Iris
authors.initials: I
authors.lastname: Jahnke
authors.forename: Klaus
authors.initials: K
authors.lastname: Diedrich
authors.forename: Peter
authors.initials: P
authors.lastname: Schmucker
authors.forename: Michael
authors.initials: M
authors.lastname: Hüppe
mesh_terms: D000328:Adult; D000577:Amides / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000779:Anesthetics, Local / Q000627:therapeutic use; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D010298:Parity; D011247:Pregnancy; D000077212:Ropivacaine; D013997:Time Factors
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine