EPIDURAL ANALGESIA AS A RISK FACTOR FOR OPERATIVE DELIVERY

Objective: To study the relationship between epidural analgesia and in strumental and non-elective cesarean delivery in the 1990s in Finland. Methods: The data was extracted from a nationwide birth register in 1 991-1993. To adjust for other factors, hospital-based analyses were ma de separately for different types of hospitals and in individual-based analyses logistic regression was used. Results: In the hospital-based analyses there was no systematic correlation between rates of epidura l analgesia and operative delivery, but on the individual level there was. Comparison of hospitals with different levels of epidural rates a nd different types of hospitals suggests that the contradictory findin gs in the hospital and individual-based analyses are partly due to sel ection bias, and partly to different hospital policies. Conclusions: T he results in previous studies and our results suggest that epidural a nalgesia is a risk factor for an operative delivery, but not a suffici ent one, and its impact is likely to be modified by other obstetric pr actices and interventions.