27. (5.) Results by individual review ‐ epidural.
| 5. Epidural versus non‐epidural or no analgesia in labour, 38 studies, 9658 women (Anim‐Somuah 2011) | |||
| 5.1. Epidural versus non‐epidural/no analgesia | Outcome |
No. of studies (no. women) |
Results |
| Pain intensity (during whole of labour), using visual analogue score (VAS) 0 to 10, where 0 represents no pain and 10 worst pain | 3 (1166 women) | Average mean difference (MD) ‐3.36, 95% CI ‐5.41 to ‐1.31 (random effects: heterogeneity: I2 = 98%, Tau2 = 3.14, Chi2 test for heterogeneity P <0.00001), a significant reduction in pain intensity for women receiving epidural | |
| Pain intensity (in the first stage of labour) VAS | 4 (589 women) | Average mean difference (MD) ‐16.35, 95% CI ‐25.11 to ‐7.58 (random effects: heterogeneity: I2 = 87%, Tau2 = 65.03, Chi2 test for heterogeneity P <0.0001), a significant reduction in pain intensity for women receiving epidural | |
| Pain intensity (in the second stage of labour) VAS | 3 (559 women) | Average mean difference (MD) ‐25.29, 95% CI ‐40.48 to ‐10.11 (random effects: heterogeneity: I2 = 96%, Tau2 = 162.74, Chi2 test for heterogeneity P <0.00001), a significant reduction in pain intensity for women receiving epidural | |
| Maternal satisfaction with pain relief – dichotomous data: the proportion of women rating their satisfaction with analgesia as excellent, very good, good after delivery in each group | 7 (2929 women) | Average RR 1.31, 95% CI 0.84 to 2.05 (random effects: heterogeneity: I2 = 100%, Tau2 = 0.36, Chi2 test for heterogeneity P <0.00001), no evidence of a significant difference | |
| Maternal satisfaction with pain relief – continuous data | 2 (272 women) | Average standardised mean difference (SMD) 0.10, 95% CI ‐0.49 to 0.70 (random effects: heterogeneity: I2 = 62%, Tau2 = 0.12, Chi2 test for heterogeneity P = 0.10), no evidence of a significant difference | |
| Sense of control in labour (feelings of poor control) | 1 (344 women) | RR 1.17, 95% CI 0.62 to 2.21, no evidence of a significant difference | |
| Satisfaction with childbirth experience | 1 (332 women) | RR 0.95, 95% CI 0.87 to 1.03, no evidence of a significant difference | |
| Effect (negative) on mother/baby interaction | Outcome not reported | ||
| Breastfeeding | Outcome not reported | ||
| Assisted vaginal birth | 23 (7935 women) | RR 1.42, 95% CI 1.28 to 1.57, significantly more women in the epidural group had assisted vaginal birth | |
| Caesarean section | 27 (8417 women) | RR 1.10, 95% CI 0.97 to 1.25, no evidence of a significant difference | |
| Caesarean section for fetal distress | 11 (4816 women) | RR 1.43, 95% CI 1.03 to 1.97, 11 trials, an increased risk of caesarean section for fetal distress | |
| Adverse effects for women (long‐term backache) | 3 (1806 women) | RR 0.96, 95% CI 0.86 to 1.07, no evidence of a significant difference | |
| Adverse effects for women (maternal hypotension) | 8 (2789 women) | RR 18.23, 95% CI 5.09 to 65.35, (random effects: heterogeneity: I2 = 47%, Tau2 = 1.57, Chi2 test for heterogeneity P = 0.07), significantly greater risk of hypotension in women in the epidural group | |
| Adverse effects for women (postnatal depression) | 1 (313 women) | RR 0.63, 95% CI 0.38 to 1.05, no evidence of a significant difference | |
| Adverse effects for women (motor blockade) | 3 (322 women) | RR 31.67, 95% CI 4.33 to 231.51, significantly greater risk of motor blockade in women in the epidural group | |
| Adverse effects for women (headache) | 3 (1198 women) | RR 0.96, 95% CI 0.81 to 1.15, no evidence of a significant difference | |
| Adverse effects for women (nausea and vomiting) | 12 (3187 women) | Average RR 0.95, 95% CI 0.72 to 1.27, random effects: heterogeneity: I2 = 49%, Tau2 = 0.09, Chi2 test for heterogeneity P = 0.03), no evidence of a significant difference | |
| Adverse effects for women (itching) | 3 (230 women) | RR 1.46, 95% CI 0.51 to 4.16, no evidence of a significant difference | |
| Adverse effects for women (fever) | 6 (2741 women) | RR 3.34, 95% CI 2.63 to 4.23, significantly greater risk of fever in women in the epidural group | |
| Adverse effects for women (shivering) | 1 (20 women) | RR 5.00, 95% CI 0.27 to 92.62, no evidence of a significant difference | |
| Adverse effects for women (drowsiness) | 4 (641 women) | Average RR 0.55, 95% CI 0.07 to 4.26, random effects: heterogeneity I2 = 94%, Tau2 = 3.47, Chi2 test for heterogeneity P < 0.00001), no evidence of a significant difference | |
| Adverse effects for women (urinary retention) | 3 (283 women) | RR 17.05, 95% CI 4.82 to 60.39, significantly greater risk of urinary retention in women in the epidural group | |
| Adverse effects for women (catheterization during labour) | 2 (1103 women) | RR 1.81, 95% CI 0.44 to 7.46, no evidence of a significant difference | |
| Adverse effects for women (malposition) | 4 (673 women) | RR 1.40, 95% CI 0.98 to 1.99, no evidence of a significant difference | |
| Adverse effects for women (surgical amniotomy) | 2 (211 women) | Average RR 1.03, 95% CI 0.74 to 1.43, random effects: heterogeneity I2 = 81%, Tau2 = 0.05, Chi2 test for heterogeneity P = 0.02, no evidence of a significant difference | |
| Adverse effects for infants (acidosis pH less than 7.2) | 7 (3643 women) | RR 0.80, 95% CI 0.68 to 0.94, neonates of women who had epidural had a significantly lower risk of acidosis | |
| Adverse effects for infants (acidosis pH less than 7.15) | 2 (382 women) | RR 0.95, 95% CI 0.50 to 1.79, no evidence of a significant difference | |
| Adverse effects for infants (naloxone administration) | 10 (2645 women) | RR 0.15, 95% CI 0.10 to 0.23, neonates of women who had epidural had a significantly lower risk of requiring naloxone | |
| Adverse effects for infants (meconium staining of liquor) | 5 (2295 women) | RR 1.01, 95% CI 0.84 to 1.21, no evidence of a significant difference | |
| Admission to special care baby unit/neonatal intensive care unit | 7 (3125 women) | RR 1.19, 95% CI 0.94 to 1.50, no evidence of a significant difference | |
| Apgar score less than seven at five minutes | 18 (6898 women) | RR 0.80, 95% CI 0.54 to 1.20, no evidence of a significant difference | |
| Poor infant outcomes at long‐term follow‐up | Outcome not reported | ||
| Cost | Outcome not reported | ||
I2 values reported in table only when random effects analysis has been carried out due to substantial heterogeneity indicated by an I2 value greater than 30% CI: confidence interval; MD: mean difference; RR: risk ratio