Cochrane Briefs

Am Fam Physician. 2005 Apr 1;71(7):1303.

Effects of Discontinuing Epidurals in Late Labor

Clinical Question

Does discontinuing epidural analgesia in the second stage of labor reduce rates of instrumented delivery or change patient satisfaction with labor?

Evidence-Based Answer

Based on three good studies of 462 patients, discontinuing epidural analgesia in the second stage of labor does not significantly change rates of instrumented delivery or other delivery outcomes, but it increases rates of inadequate pain relief.

Practice Pointers

The American College of Obstetricians and Gynecologists1 supports the use of epidural analgesia during labor. The policy states that epidurals should not be denied because of the patient’s insurance and that nurses should not be restricted from managing regional anesthesia.1 Because epidural analgesia provides the highest level of pain relief, the physician and patient should decide when it should be used. However, there are concerns that epidural analgesia increases rates of instrumented deliveries. To reduce this risk, physicians sometimes discontinue epidural analgesia during the second stage of labor. Torvaldsen and colleagues reviewed the literature to determine if this practice improves outcomes.

The authors found five studies, three of which were good quality. They did not find a statistically significant difference in rates of instrumented delivery or cesarean delivery, duration of the second stage of labor, low Apgar scores, or fetal malposition at delivery. The only statistically significant difference was an increased rate of inadequate pain relief during the second stage of labor.

Some women may be willing to accept discomfort in the second stage of labor even if the risk of poor outcomes is small. A larger study is needed to determine if there is a difference in outcomes. There is inadequate data to support the practice of discontinuing epidural analgesia in the second stage of labor.

REFERENCES

1. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 295: pain relief during labor. Obstet Gynecol. 2004;104:213.


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