What is it about?

A recent Cochrane review of randomised controlled studies concluded that epidural analgesia in labour does not increase the risk of an emergency caesarean section. A closer look at the Cochrane review revealed most studies were of low-risk women in advanced spontaneous labour. A comparison between 200 high-risk labours and a comparable population in one of the Cochrane review studies revealed a marked difference in labour outcomes. Potential reasons for the discrepancy with the Cochrane review findings may include differences in anaesthetic practice, timing and dilation at the time of receiving epidural analgesia, and evidence that women taking part in a randomised controlled trials experience better outcomes than those receiving routine care.

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Why is it important?

The evidence from the current small observational study is used as a starting point to look at the evidence from two Cochrane review studies and two large cohort studies. An argument is made that epidural analgesia does increase the risk of an emergency caesarean section in the context of a contemporary labour ward environment. Three strategies to decrease the risk discussed

Perspectives

There is no evidence from either randomised controlled studies or qualitative studies that pain relief on its own improves women's satisfaction with their childbirth experiences. There is unequivocal evidence that epidural analgesia in labour increases risk of instrumental delivery, antibiotic use in labour, augmentation with oxytocin and urine retention in the postnatal period. In the author's opinion, women should be aware of this evidence when considering their pain relief options in labour. Further research on epidural analgesia and risk of an emergency caesarean section in induced labour is warranted.

Nadia Salfarlie
Guys and StThomas' NHS Foundation Trust

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This page is a summary of: Epidural analgesia in labour and the risk of emergency caesarean: a retrospective observational study, British Journal of Midwifery, August 2024, Mark Allen Group,
DOI: 10.12968/bjom.2024.32.8.404.
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