Epidural Analgesia and Risks of Cesarean and Operative Vaginal Deliveries in Nulliparous and Multiparous Women
Posted: 10/15/2010; Maternal and Child Health Journal. 2010;14(5):705-712. © 2010 Springer
source: medscape
"There was a 25.1% increase in absolute risk (95% CI: 19.8, 30.3), or a crude risk ratio of 4.0 (95% CI: 2.9, 5.5), for operative vaginal delivery among nulliparous women who had epidural anesthesia in 1st stage of labor compared to those who did not. After control of confounding by stratification on propensity score, nulliparous women who received epidural anesthesia had a 19.3% higher absolute risk for operative vaginal deliveries (95% CI: 12.9, 25.8), or a relative risk of 2.5 (95% CI: 1.8, 3.4), as compared with women without epidural. Among multiparous women, those with epidural anesthesia had a 16.6% increase in absolute risk (95% CI: 12.5, 20.8), or a crude relative risk of 11.5 (95% CI: 6.4, 20.7), for operative vaginal delivery compared to women without epidural. After adjusting for propensity score, the risk difference was 13.7% (95% CI: 9.1, 18.2), and the risk ratio was 5.9 (95% CI: 3.2, 11.1).
With regard to cesarean sections, nulliparous women who had epidural placement in first stage of labor had a 13.0% increase in absolute risk (95% CI: 8.8, 17.2), or a crude relative risk of 3.8 (95% CI: 2.4, 6.0), for this method of delivery compared with women without epidural placement in the first stage of labor. Adjusting for propensity score, there was a 10.4% increase in absolute risk (95% CI: 5.2, 15.7), or a 2.4 relative risk (95% CI: 1.5, 3.7), for cesarean sections. As for multiparous women, those who had epidural placement in the first stage of labor had a 2.0% increase in absolute risk (95% CI: 0.1, 3.9), or a relative risk of 3.3 (95% CI: 1.3, 8.7), for cesarean delivery. After adjusting for confounding, the adjusted risk difference was 1.2% (95% CI: -0.9, 3.3), and the adjusted risk ratio was 1.8 (95% CI: 0.6, 5.3)."
The "Humanized Delivery" refers not only to a painless labour, of course. Lower back massage, breathing, showers, company of the parturient's couple or parent play an important role on the subject. But, my very personal opnion, nobody could think of an humanized delivery without the pharmacological pain relief provided by an epidural. At least until now...
