The effect of instituting an elective labor epidural program on the operative delivery rate

To evaluate labor outcome as well as maternal and neonatal morbidity before and after the initiation of elective labor epidural capability.

On October 1, 1993, a sudden change in military requirements mandated provision of elective labor epidural capability at our institution. Before this time, epidural provision had been primarily in response to urgent obstetrician requests. Pre-labor and labor characteristics and outcomes were reviewed for the year before this policy change (group 1, n = 373) and for the year after it (group 2, n = 421) in a population of nulliparous patients delivering singleton, vertex fetuses at 36-42 weeks' gestational age. In addition, the group of patients receiving labor epidurals before their ready availability (group 1E, n = 49) was compared with the group receiving them after ready availability (group 2E, n = 247).

Maternal labor characteristics showed a slight (10 minutes on average) prolongation of the second stage of labor in group 2. The incidence of diagnosed chorioamnionitis was higher in group 2. Patients receiving epidurals in each time frame were analyzed to identify epidural-related findings, as opposed to findings associated with intrinsically more problematic labors. Epidural-related factors included the slightly prolonged second stage of labor, increased use of oxytocin, and a higher incidence of diagnosed chorioamnionitis.

Our study demonstrated no increase in the rate of operative deliveries in a population that suddenly received access to on-request labor epidurals. We believe this option should be offered to parturients without making them feel that they must choose between comfort and safety.