Most patients who choose epidural analgesia in labour are just as likely to have a vaginal delivery as those who do not
Current epidural analgesia in labour uses a combination of low-concentration local anesthetics and opioid to optimize pain control while minimizing motor block. This type of analgesia does not increase the risk of cesarean delivery.1 In trials conducted since 2005, there was no difference in the proportion of women with an assisted vaginal delivery.1 Most trials were conducted in women with a single fetus and uncomplicated pregnancies.
Epidural analgesia in labour is safe and effective, including in patients who are dependent on opioids
In a national audit in the United Kingdom, the incidence of any permanent harm, including death, after an epidural in the obstetric population was 0.6 per 100 000.2 Compared with opioid analgesia, epidural analgesia in labour is superior for both pain intensity and satisfaction with pain relief.1 Women who are dependent on opioids, including those taking methadone and buprenorphine, have been found to have similar needs and analgesic responses during labour.3
Epidural analgesia in labour is rarely the cause of a neurologic complication
Most neurologic complications postpartum are obstetric palsies from nerve compression by the fetal head, or positional related stretching of nerves.4 A thorough evaluation of any neurologic complications is always required to determine the cause.
It is not necessary to wait until a specific measurement of dilation before beginning epidural analgesia in labour
The risk of cesarean delivery does not increase if epidural analgesia in labour is started in early labour, before 4 cm dilation. Epidurals can safely be placed at any stage of labour, including the second stage.5
There is no increased risk of long-term backache with epidural analgesia in labour
Epidural analgesia in labour is not associated with long-term back pain compared with nonepidural analgesia.1 Insertion of an epidural needle can cause short-term, localized pain at the insertion site, which may last several days.1 Other potential adverse effects include hypotension, pruritis, nausea and vomiting, urinary retention, fever and shivering.1
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Footnotes
Competing interests: None declared.
This article has been peer reviewed.
References
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