title: Epidural analgesia and operative delivery: a ten-year population-based cohort study in The Netherlands.
abstract: OBJECTIVE
  To describe trends in the use of epidural analgesia (EA) and to evaluate the association of EA with operative deliveries.
  
  
  METHODS
  In this population-based, retrospective cohort study, women with an intention to deliver vaginally of a term, cephalic, singleton between 2000 and 2009 (n=1378458) were included. Main outcome measures were labor EA rates, unplanned caesarean section (CS), and instrumental vaginal delivery (IVD) including deliveries by either vacuum or forceps. Data were obtained from the Perinatal Registry of The Netherlands and logistic regression analyses were used.
  
  
  RESULTS
  Among nulliparous, EA use almost tripled over the 10-year span (from 7.7% to 21.9%), while rates of CS and IVD did not change much (+2.8% and -3.3%, respectively). Among multiparous, EA use increased from 2.4% to 6.8%, while rates of CS and IVD changed slightly (+0.8% and -0.7%, respectively). Multivariable analysis showed a positive association of EA with CS, which weakened in ten years, from an adjusted OR of 2.35 (95% CI, 2.18 to 2.54) to 1.69 (95% CI, 1.60 to 1.79; p<0.001) in nulliparous, and from an adjusted OR of 3.17 (95% CI, 2.79 to 3.61) to 2.56 (95% CI, 2.34 to 2.81; p<0.001) in multiparous women. A weak inverse association between EA and IVD was found among nulliparous (adjusted OR, 0.76; 95% CI, 0.75 to 0.78), and a positive one among multiparous women (adjusted OR, 2.08; 95% CI, 2.00 to 2.16). Both associations grew slightly weaker over time.
  
  
  CONCLUSIONS
  A near triplication of EA use in The Netherlands in ten years was accompanied by relatively stable rates of operative deliveries. The association between EA and operative delivery became weaker. This supports the idea that EA is not an important causal factor of operative deliveries.
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, GROW-School for Oncology and Developmental Biology, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: martine_wassen@hotmail.com.
authors.forename: Martine M L H
authors.initials: MM
authors.lastname: Wassen
authors.affiliation: The Netherlands Perinatal Registry, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands.
authors.forename: Chantal W P M
authors.initials: CW
authors.lastname: Hukkelhoven
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, GROW-School for Oncology and Developmental Biology, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Hubertina C J
authors.initials: HC
authors.lastname: Scheepers
authors.affiliation: Caphri School for Public Health and Primary Care, Department of Epidemiology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
authors.forename: Luc J M
authors.initials: LJ
authors.lastname: Smits
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, GROW-School for Oncology and Developmental Biology, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Nijhuis
authors.affiliation: Department of Obstetrics and Gynaecology, Atrium Medical Centre Parkstad, Henri Dunantstraat 5, 6401 CX Heerlen, The Netherlands.
authors.forename: Frans J M E
authors.initials: FJ
authors.lastname: Roumen
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data* / Q000639:trends; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data* / Q000639:trends; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D015331:Cohort Studies; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009426:Netherlands; D011247:Pregnancy; D012189:Retrospective Studies
keywords: Caesarean section; Epidural analgesia; Instrumental vaginal delivery; Operative delivery