Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study |
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| Affiliation: | 1. School of Nursing and Midwifery, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia;2. School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St., Dublin 2, Ireland;1. Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, Northampton Square, London EC1V 0HB, UK;2. St. Georges University Hospital, Maternal-Fetal Research Department, Blackshaw Road, London SW17 0QT, UK;1. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st, St SW, Rochester, MN, United States;2. Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st, St SW, Rochester, MN, United States;1. Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands;2. Department of Anesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands;3. Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands;4. Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands;1. Department of Paediatrics, Gynaecology & Obstetrics, Geneva University Hospitals, Switzerland;2. Faculty of Medicine, University of Geneva, Switzerland;3. Department of Anaesthesia, Pharmacology and Intensive Care, Geneva University Hospitals, Switzerland;4. Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva, Switzerland;1. Department of Obstetrics and Gynaecology, Grow School of Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands;2. Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Heerlen, The Netherlands;3. Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands;4. Department of Health Services Research, Caphri School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands |
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| Abstract: | ObjectiveTo compare labour and birth outcomes between nulliparous women who used versus did not use intrapartum epidural analgesia.DesignProspective cohort study.SettingTwo maternity hospitals in Ireland.PopulationA total of 1221 nulliparous women who gave birth vaginally or by emergency caesarean section.MethodsMultinomial logistic regression was used to analyse categorical outcomes, with results presented as ratios of relative risks (RRR). For dichotomous outcomes we used logistic regression, with results presented as odds ratios (OR).Main outcome measuresMode of birth, IV syntocinon use, pyrexia (≥38 °C), antibiotic treatment, first stage labour ≥10 h, second stage labour ≥2 h, blood loss (≥500 mls, ≥1000 mls), perineal trauma. Neonatal outcomes included Apgar score ≥7 at 1 min and 5 min, admission to neonatal intensive care unit, and infant feeding method.ResultsWomen using EA were more likely to require a vacuum-assisted birth (RRR 3.35, p < 0.01) or forceps-assisted birth (RRR 11.69, p < 0.01). Exposure to EA was associated with significantly greater risk of ≥10 h first (OR 6.72, p = 0.01) and ≥2 h second (OR 2.25, p < 0.01) stage labour, increased likelihood of receiving IV syntocinon (OR 9.38, p < 0.01), antibiotics (OR 2.97, p < 0.01) and a greater probability of pyrexia (OR 10.26, p < 0.01). Women who used EA were half as likely to be breastfeeding at three months postpartum (OR 0.53, p < 0.01). No differences were observed between groups in neonatal outcomes.ConclusionsOur data shows significant associations between EA use and several intrapartum outcomes. |
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| Keywords: | Analgesia Epidural Breast feeding Childbirth Cohort studies Pain management |
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