The Cochrane Library newsletter, 2005, Issue 4

Epidurals in labor and delivery reduce pain but can increase the risk of needing forceps

Pain relief is an important issue for women in labour and epidurals are increasingly used. They reduce pain, but increase the likelihood of an instrumental delivery. Currently there is a lack of evidence that epidurals increase the risk of having a caesarean delivery, but women who use epidural have a longer second stage of labour compared to those who use other forms of pain relief.

Epidurals, first introduced in 1946, are now used by about one-fifth of women in the UK and one-half of women in the USA during labour. In an epidural, anaesthetic agents are injected into the lower region of the spine. This blocks the activity of the nerves that transmit painful stimuli from the birth canal to the brain, which results in pain relief.

A systematic review of literature included 21 studies of epidural pain-relief in labour, involving 6664 women. The Cochrane Review Authors drew several conclusions from these data.

When compared to women using other forms of pain relief in labor, women who use epidurals have better pain relief, longer second stage of labor, increased likelihood of having an instrumental delivery, and increased likelihood of having fever during labor.

There was a lack of evidence that epidurals affect the new-born, increase the likelihood of caesarean delivery, increase the likelihood of long term backache, and affect maternal satisfaction.

"The evidence in this review needs to be made available to women considering pain relief in labour," says lead author Millicent Anim-Somuah, an honorary Research Fellow at the School of Reproductive and Developmental Medicine, at Liverpool Women's Hospital NHS Trust, Liverpool, UK.

Review title: Anim-Somuah M et al. Epidural versus non-epidural ornoanalgesia in labour. The Cochrane Database of Systematic Reviews 2005, Issue 4.

Not enough evidence to recommend

Contact: Amy Molnar
John Wiley & Sons, Inc.

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