EPIDURAL ANALGESIA IN ACTIVE MANAGEMENT OF LABOR

Objectives. To examine the determinants of epidural analgesia in the a ctive management of labor. To examine the association of epidural with instrumental delivery and cesarean section. Study Design. Observation al study in a teaching hospital with a uniform active labor management and availability of epidural analgesia on demand. A. thousand consecu tive nulliparous women at term, were assessed. Results. Requests for e pidural anesthesia were predominantly expressed at the time the patien t was notified that spontaneous labor was going to be augmented by the administration of oxytocin, or later, when this latter treatment caus ed labor to be subjectively more arduous. In induced labor, the same o bservation applied to a greater degree, still. Operative delivery was significantly more frequent in patients with epidural. However, when t he incidence of operative delivery was adjusted for the use of oxytoci n, the significance between patients with epidural versus the others a bated. Conclusion. The use of oxytocin in active management of labor r esults in a high demand for epidural when this is available on demand. This, however, need not be associated with an increased incidence of operative delivery.