Epidural versus non-epidural analgesia for pain relief in labour

BACKGROUND: Epidural analgesia is effective in reducing labour pain, but the possible adverse effects are not clear. OBJECTIVES: The objective of this review was to assess the effects of epidural analgesia on pain relief and adverse effects in labour. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register was searched. SELECTION CRITERIA: Randomised trials comparing epidural analgesia with other forms of analgesia not involving regional blockade, or no intervention. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information. MAIN RESULTS: Eleven studies involving 3157 women were included. Epidural analgesia was associated with greater pain relief than non-epidural methods, but also with longer first and second stages of labour, an increased incidence of fetal malposition, and increased use of oxytocin and instrumental vaginal deliveries. With new trial data included, no statistically significant effect on caesarean section rates could be identified. REVIEWER'S CONCLUSIONS: Epidural analgesia appears to be very effective in reducing pain during labour, although there appear to be some potentially adverse effects. Further research is needed to investigate adverse effects and to evaluate the different techniques used in epidural analgesia.