Epidural analgesia: effects on labor progress and maternal and neonatal outcome

The intended and unintended effects of epidural labor analgesia are reviewed. Mothers randomized to epidural rather than parenteral opioid analgesia have better pain relief. Fetal oxygenation is not affected by analgesic method; however, neonates whose mothers received intravenous or intramuscular opioids rather than epidural analgesia require more naloxone and have lower Apgar scores. Epidural analgesia does not affect the rates of cesarean delivery, obstetrically indicated instrumented vaginal delivery, neonatal sepsis, or new-onset back pain. Epidural analgesia is associated with longer second labor stages, more frequent oxytocin augmentation, and maternal fever (particularly among women who shiver and women receiving epidural analgesia for > 5 hours) but not with longer first labor stages. Epidural analgesia has no affect but intrapartum opioids decrease lactation success. Epidural use and urinary incontinence are weakly, but probably not causally, associated. Epidural labor analgesia would improve if the mechanisms of these unintended effects could be determined.