Effect of epidural analgesia on the primary cesarean rate

There is some concern that providing parturients with epidural analgesia increases the likelihood of cesarean delivery. Because of the widespread interest in cesarean rates and the expanding use of epidural analgesia, we believed that this contention should be assessed. Hospital records were reviewed to determine the primary cesarean rate for 1084 parturients who delivered at our institution during 15 months in which there was a 24-hour "on demand" epidural service. This was compared with our primary cesarean rate during 15 months in which epidural analgesia was not available, even on physician request. Because of the characteristics of our institution, this control group consisted of patients from the same population base managed by the same eight obstetricians using the same management techniques. For patients in labor, the primary cesarean rate overall was 9.0% before and 8.2% after the epidural service began (P = .626). When subpopulations based on parity and indication for cesarean delivery were studied, there were no significant changes in the cesarean rate. These results demonstrate that the availability of on-demand epidural analgesia for patients in labor did not increase the primary cesarean rate, either in the aggregate or for any of the subpopulations studied.