DOES EPIDURAL ANALGESIA DURING LABOR AFFECT THE INCIDENCE OF CESAREANDELIVERY

There is substantial evidence that there is an increased incidence of cesarean delivery among patients who receive epidural analgesia during labor. The controversy as to whether there is a causal relationship b etween epidural analgesia and cesarean delivery. Two prospective, rand omized studies suggest that epidural analgesia may increase the incide nce of operative delivery in laboring women. However, retrospective po pulation-based studies suggest that the introduction of an epidural an algesia service, or the increased use of epidural analgesia, does not increase the cesarean delivery rate. It is possible that epidural anal gesia during labor may increase the risk of cesarean delivery in selec ted patients. Such an effect-if it exists at all-appears to be small i n contemporary practice, Furthermore, the availability and use of epid ural analgesia may encourage other patients to undergo an adequate tri al of labor or attempt vaginal birth after cesarean delivery. It is im portant to consider the impact of epidural analgesia on the total popu lation of obstetric patients. Maternal-fetal factors and obstetric man agement, not epidural analgesia, are the most important determinants o f the cesarean delivery rate. Finally, physicians should remember that pain relief is itself a worthy goal.