142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Epidural Analgesia use during Labor and Adverse Maternal and Neonatal Outcomes: A Large-Scale Observational Study

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 11:30 AM - 11:50 AM

Kristen Kjerulff, MA, PhD , Public Health Sciences, Penn State University College of Medicine, Hershey, PA
Junjia Zhu, PhD , Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, PA

Background:  The use of epidural analgesia in labor has increased rapidly in the past two decades and it is estimated that more than 75% of women in the US receive epidural analgesia in childbirth.  Few studies have measured unintended outcomes of the use of epidural analgesia in the natural setting.  Methods:  3,006 women aged 18-36 years old delivering their first child in Pennsylvania in 2009-2011 were interviewed 1 month after birth, and the birth certificate and hospital discharge data were obtained.  Results:  Overall, 2,851 (94.8%) women labored and 155 (5.2%) had a planned cesarean delivery. Among those who labored 2,457 (86.2%) reported that they received epidural analgesia during labor, 92 (3.2%) received narcotics only, 222 (7.8%) did not use pain medication and 80 (2.8%) used some type of pain medication, but did not know what.  Women who received epidural analgesia labored an average of 6.4 hours longer than those who did not (15.04 hours vs 8.6 hours, p < .0001), were more likely to have augmented labor (34.1% vs 19.4%, p < .0001), unplanned cesarean (26.8% vs. 6.4%, p < .0001), fetal distress (23.9% vs 13.4%, p < .0001), newborn 5-minute Apgar < 8 (5.0% vs 1.3%, p = .003) and NICU admission (5.0% vs. 1.3%, p = .005).  Conclusion:  In this large-scale, observational study of first childbirth we found that epidural analgesia was associated with increased risk of adverse outcomes for women and their newborns.  Further studies of the unintended effects of epidural use in childbirth are critical.

Learning Areas:

Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related nursing

Learning Objectives:
List 5 types of pain management treatments used during labor Describe the adverse maternal and neonatal outcomes associated with the use of epidural analgesia during labor Articulate at least one hypothesis that could explain the association found in this study and others between epidural use in labor and adverse birth outcomes

Keyword(s): Birth Outcomes, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am principal investigator of the study described in the abstract, I have masters and doctoral degrees in psychology, and have been conducting research in the area of women's health for the past 25 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.