Epidurals Do Not Increase C-Section Rates

Contrary to previous research, spinal-epidural analgesia given early in labor (cervical dilation of less than four centimeters) does not increase rates of cesarean section, according to results of a study by Cynthia Wong, MD, associate professor of anesthesiology, and colleagues appearing in the February 17 issue of the New England Journal of Medicine.

Based on earlier research, the American College of Obstetricians and Gynecologists recommended that epidural analgesia for first-time mothers be delayed until dilation of greater than four centimeters and that other forms of analgesia such as systemic opioids be given instead. Dr. Wong and colleagues studied 750 women randomized to receive spinal fentanyl or systemic hydromorphone at their first request for analgesia. Epidural analgesia was given to the spinal group at their second request for pain relief and to the systemic group when dilation exceeded four centimeters. Rates of cesarean section were similar for the groups (18 percent in the spinal group, 21 percent in the systemic group). Vaginal delivery was significantly shorter (by 81 minutes) and pain scores significantly lower in the spinal-epidural group. In addition, median time from initiation of analgesia to full dilation was 90 minutes shorter in this group.