The effect of a rapid change in availability of epidural analgesia on the cesarean delivery rate: A meta-analysis

OBJECTIVE:This study was undertaken to quantitatively estimate the effect o f a rapid introduction or withdrawal of on-demand epidural analgesia on the cesarean delivery rate. STUDY DESIGN: MEDLINE and meeting abstracts were searched for studies repor ting the cesarean delivery rate immediately before and after a rapid change in the availability of epidural analgesia. Nine studies reporting data on 37,753 patients were selected. Meta-analysis was performed to estimate the means and 95% confidence intervals for the changes in rates of total cesare an deliveries, cesarean deliveries among nulliparous women, cesarean delive ries for dystocia, and operative vaginal deliveries. RESULTS: There was no significant change in the overall cesarean delivery r ate with an increase in the availability of epidural analgesia. Similarly, the rates of cesarean deliveries among nulliparous patients, of cesarean de liveries for dystocia, and of operative Vaginal deliveries did not signific antly differ between periods of high and low epidural analgesia availabilit y. CONCLUSION: A rapid change in the availability of epidural analgesia is not associated with any increase in the cesarean delivery rate.