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

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.