NO FREE LUNCH ON LABOR DAY: The Risks and Benefits of Epidural Analgesia During Labor

Authors

  • Ellice Lieberman MD, DrPH

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    • 1Ellice Lieberman is currently appointed as Associate Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School and as Associate Professor of Maternal and Child Health at the Harvard School of Public Health. She is also Director of the Center for Perinatal Research at Brigham and Women's Hospital in Boston.


2Address correspondence to Ellice Lieberman, MD, DrPH, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

ABSTRACT

Epidural analgesia provides effective pain relief for women during labor. However, like all medical interventions, it also has potential side effects such as longer labor and a higher rate of intrapartum fever and operative vaginal delivery. A recent meta-analysis of randomized studies by Halpern et al concluded there was no association between epidural use and cesarean delivery.

A critique of that meta-analysis, included in this paper, concludes that there are currently insufficient data to determine whether epidural analgesia leads to increased rates of cesarean delivery. This paper also presents results from several recent studies related to epidural analgesia conducted at Brigham and Women's Hospital in Boston. One study demonstrates a significant influence of prenatal planning on use of epidural during labor. Additional studies examine the strong association of epidural analgesia with intrapartum fever and the consequences of that fever for mother and infant.

Epidural analgesia should remain an option available to women during labor. A more complete understanding of the risks and benefits that accompany its use is essential so that women and their care providers can make informed choices about pain relief during labor. J Nurse Midwifery 1999;44:394–8 © 1999 by the American College of Nurse-Midwives.

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