TOPLINE

In women with uncomplicated, low-risk pregnancies, epidural analgesia (EA) during labor was associated with prolonged first and second stages of labor and increased rates of clinical interventions, such as cesarean section.

METHODOLOGY

• Retrospective cohort study conducted at a maternity hospital in northern Italy analyzed 3406 women aged 18-45 years with uncomplicated, low-risk pregnancies who gave birth between 2019 and 2023.
• A total of 417 women received EA and 2989 used only non-pharmacological pain relief methods.
• Inclusion criteria comprised singleton pregnancy in cephalic presentation, gestational age 37-41 weeks, estimated fetal weight 2500-4000 g, spontaneous onset of active labor, and no uterine scars or pregnancy complications.
• Various variables were analyzed such as maternal demographics and obstetric history, epidural characteristics, intrapartum factors (labor progression), and maternal and neonatal outcomes.

TAKEAWAY

• Women receiving EA experienced significantly prolonged first stage of labor (coefficient, 313.0; 95% CI, 299.8-326.1) and second stage of labor (coefficient, 56.4; 95% CI, 51.3-61.4) compared with those who did not receive EA.
• EA was associated with higher odds of delayed first stage requiring pharmacological augmentation (adjusted odds ratio [aOR], 24.3; 95% CI, 17.8-33.6) and higher odds of delayed second stage of labor (aOR, 5.0; 95% CI, 3.8-6.6).
• EA was associated with higher odds of cesarean section (aOR, 7.2; 95% CI, 3.1-17.1) and urinary retention (aOR, 6.0; 95% CI, 3.1-11.5). EA was associated with more than double the odds of lithotomy position at birth (aOR, 2.3; 95% CI, 1.7-3.0).
• No significant differences between groups were found within postpartum maternal outcomes and in neonatal outcomes such as Apgar scores, early skin-to-skin contact, or admission to the NICU.

IN PRACTICE

"While causality cannot be inferred, the findings contribute to a growing body of evidence suggesting that EA use may be associated with alterations of the normal pattern of labour and intrapartum care. In clinical practice, our findings highlight the importance of careful monitoring of labour progression and the use of evidence-based approaches to intrapartum care, while avoiding unnecessary interventions," the authors of the study wrote.

SOURCE

The study was led by Simona Fumagalli, University of Milan–Bicocca in Milan, Italy. It was published online on August 3 in BMJ Open.

LIMITATIONS

The study design and use of routinely collected data limited adjustment for unmeasured confounders. Selection bias related to the characteristics of mothers, how labor progressed, and personal preferences cannot be excluded, as EA was not randomly assigned. The higher proportion of first-time mothers in the EA group and lack of stratification by cervical dilatation at admission might have affected labor progression assessments. Restriction to low-risk pregnancies may limit how well the findings apply to more complex obstetric populations.

DISCLOSURES

The authors did not declare any specific grant or competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.