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Mode of Delivery after Epidural Analgesia in a Cohort of Low-Risk Nulliparas

Authors

  • Lena Mariann Eriksen RM, MHSc,

    1. Lena Mariann Eriksen is a Lecturer in Midwifery at the Danish Midwifery Education, University College Metropol, Copenhagen; Ellen A. Nohr is an Associate Professor at the Department of Epidemiology, Institute of Public Health and Head of the Master in Health Sciences Program, University of Aarhus, Aarhus; and Hanne Kjærgaard is Head of Research at the Research Unit Women’s and Children’s Health, the Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, and a Clinical Associate Professor at the Institute of Gynecology, Obstetrics and Pediatrics, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.
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  • Ellen A. Nohr RM, MHSc, PhD,

    1. Lena Mariann Eriksen is a Lecturer in Midwifery at the Danish Midwifery Education, University College Metropol, Copenhagen; Ellen A. Nohr is an Associate Professor at the Department of Epidemiology, Institute of Public Health and Head of the Master in Health Sciences Program, University of Aarhus, Aarhus; and Hanne Kjærgaard is Head of Research at the Research Unit Women’s and Children’s Health, the Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, and a Clinical Associate Professor at the Institute of Gynecology, Obstetrics and Pediatrics, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.
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  • Hanne Kjærgaard RM, PhD

    1. Lena Mariann Eriksen is a Lecturer in Midwifery at the Danish Midwifery Education, University College Metropol, Copenhagen; Ellen A. Nohr is an Associate Professor at the Department of Epidemiology, Institute of Public Health and Head of the Master in Health Sciences Program, University of Aarhus, Aarhus; and Hanne Kjærgaard is Head of Research at the Research Unit Women’s and Children’s Health, the Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, and a Clinical Associate Professor at the Institute of Gynecology, Obstetrics and Pediatrics, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.
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  • Data included in this study were provided from the Danish Dystocia Study, which has obtained funding from the following institutions and foundations: Copenhagen Hospital Corporation Research Foundation, the Lundbaeck Foundation, Aase and Ejnar Danielsen’s Foundation, the Augustinus Foundation, the Health Insurance Foundation, the Danish Midwifery Association, King Christian X’s Foundation, Copenhagen, Denmark; and Faculty of Medicine, Lund University, Lund, Sweden. These foundations also supported the writing of this manuscript.

Address correspondence to Lena Mariann Eriksen, RM, MHSc, Vig Hovedgade 22C, st. mf, DK 4560 Vig, Denmark.

Abstract

Abstract:  Background:  Although epidural analgesia is widespread and very effective for alleviating labor pain, its use is still controversial, as the literature is inconsistent about the risk of adverse birth outcome after administration of epidural analgesia. The aim of this study was to explore associations between epidural analgesia and mode of delivery.

Methods:  Data were obtained from a prospective cohort from nine Danish labor wards and comprised 2,721 term nulliparous women with spontaneous onset of labor and a singleton fetus in cephalic presentation. Information about epidural analgesia, mode of delivery, and birth complications was obtained by the staff attending labor. Additional information was provided from self-administered questionnaires in gestational week 37. Multiple logistic regression analyses were used to estimate the association between epidural analgesia and birth outcomes. Results are presented as crude and adjusted odds ratios (OR [95% CI]).

Results:  Of the total cohort, 21.6 percent required epidural analgesia, 8.7 percent had emergency cesarean section, and 14.9 percent had vacuum extraction. Women with epidural analgesia had a higher risk of emergency cesarean section (adjusted OR: 5.8; 95% CI: 4.1–8.1), and vacuum extraction (adjusted OR: 1.7; 95% CI: 1.3–2.2). In a subgroup of the cohort with a very low overall risk of cesarean section, 3.4 percent had emergency cesarean section and an increased risk of emergency cesarean section was also found in this group (adjusted OR: 3.5; 95% CI: 1.5–8.2).

Conclusions:  In nulliparous women of a very low-risk population, use of epidural analgesia for labor pain was associated with higher risks of emergency cesarean section and vacuum extraction. (BIRTH 38:4 December 2011)

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