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Epidurals and Connections with Cesareans
Thorp, JA et al (1993) The effect of intrapartum epidural anesthesia onnulliparous labor: a randomized, controlled, prospective trial. AmericanJournal of OB/GYN. 169 (4) 851-858.Nulliparas in spontaneous labor were randomized to epidural (n=48) ornarcotic (n=45 analgesia. The only cesarean in the narcotic group was theonly woman who opted out into the epidural group. The risk of cesarean withepidural was 50% at 2cm, 33% at 3cm, 26% at 4cm, and nil at 5cm. They stoppedthe study early on ethical grounds when the results became clear to theresearchers.
Thorp JA et all (1991) Epidural Anesthesia and cesarean section for dystocia:Risk factors in nulliparas. American Journal of Perinatology. 8(6) 402-410.This study is even better, because they separately analysed and comparedgroups of women receiving epidural at different dilations and stations withgroups of women receiving no epidural and then further grouped them by theirprogress in labor and were therefore able to compare the effect of theepidural on labor progress and dystocia. It is fairly confusing to abstract,but the whole text makes clear that epidural women were more likely to haveoxytocin and cesareans for dystocia.
Morton SC, Williams MS, Keeler, EB,Gambone JC, Kahn KL (1994). Effect ofepidural analgesia for labor on the cesarean delivery rate. OB/GYN. 83(6)1045-52.A meta analysis of published studies on above topic reveals a 10% increase insections when epidural was used.
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