Epidural analgesia and active management of labor: Effects on length of labor and mode of delivery

Objective: To determine whether cervical dilatation at the time of placemen t of patient-requested epidural affects cesarean rates or lengths of labors in actively managed parturients. Methods: The charts of 255 women randomized to active management of labor ( n = 125) or control protocols (n = 130) were reviewed and stratified to ear ly epidural placement (up to 4 cm cervical dilatation) versus late placemen t (more than 4 cm). Results: Women with early epidural placement had shorter labors than those with late placement (11.6 +/- 4.6 versus 13.2 +/- 5.6 hours; P = .02). Acti ve management reduced the length of labor compared with controls regardless of epidural timing, with a reduction of 1.4 hours in early epidural placem ent (10.9 +/- 4.7 versus 12.3 +/- 4.3 hours; P = .04) and 3.6 hours in thos e with later placement (11.0 +/- 3.6 versus 14.6 +/- 6.2 hours; P = .004). Cesarean rates did not vary significantly (early 14.5% versus late 7.9%; P = .21). Early epidural placement did not lengthen the second stage of labor or increase operative vaginal delivery rates. Conclusion: Early epidural placement did not affect lengths of labor or ces arean rates and was actually associated with shorter labor compared with la te epidural placement. Women managed actively in labor, regardless of timin g of epidural placement, had shorter labors than controls. (Obstet Gynecol 1999;93:995-8. (C) 1999 by The American College of Obstetricians and Gyneco logists.).