Epidural Analgesia in Labor: An Evaluation of Risks and Benefits

Authors

  • James A. Thorp MD,

    Corresponding author
    1. James Thorp is Associate Director, Saint Luke's Perinatal Center, and Associate Professor, University of Missouri at Kansas City; and Ginger Breedlove is Director, Nurse Midwife Program, Saint Luke's Hospital of Kansas City, Missouri.
      Address correspondence to James A. Thorp, MD, Saint Luke's Perinatal Center of Kansas City, Saint Luke's Hospital, 4400 Wornall Road. Kansas City, MO 64111.
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  • Ginger Breedlove CNM, MSN

    1. James Thorp is Associate Director, Saint Luke's Perinatal Center, and Associate Professor, University of Missouri at Kansas City; and Ginger Breedlove is Director, Nurse Midwife Program, Saint Luke's Hospital of Kansas City, Missouri.
    Search for more papers by this author

Address correspondence to James A. Thorp, MD, Saint Luke's Perinatal Center of Kansas City, Saint Luke's Hospital, 4400 Wornall Road. Kansas City, MO 64111.

ABSTRACT

Background: Intrapartum epidural analgesia has become increasingly popular because it is the most effective method of providing pain relief during labor. Much attention is given to its safety and efficacy, and many health care providers and consumers are unaware of its potential drawbacks. This article reviews the literature about the effects of epidural analgesia on the mother and infant.Methods:We performed a computer-assisted MEDLINE search for articles and a review of bibliographies from articles on epidural analgesia. When reported data were incomplete, authors were contacted for more detailed information.Results:The most common procedure-related complications, hypotension, inadvertent dural puncture, and headache, are easily treated and usually self-limited. Permanent morbidity and mortality are rare. Retrospective studies and randomized controlled trials both demonstrate that epidural analgesia is associated with increases in duration of labor, instrument vaginal delivery, and cesarean birth. To date only three trials randomized patients to narcotic versus epidural groups, and all showed a twofold to threefold increase in cesarean section for dystocia. Limiting epidural use in nulliparous labor and delaying its placement until after 5 cm of cervical dilation may reduce the risk of operative intervention for dystocia. Epidural analgesia may also increase intervention for fetal distress. Several studies show its association with maternal fever in labor. Its association with chronic back pain, neonatal behavioral changes, and maternal-infant bonding are more tenuous and require further study.Conclusions:Epidural analgesia is a safe and effective method of relieving pain in labor, but is associated with longer labor, more operative intervention, and increases in cost. It must remain an option; however, caregivers and consumers should be aware of associated risks. Women should be counseled about these risks and other pain-relieving options before the duress of labor.

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