Epidural Analgesia and Active Management of Labor

In Brief Objective To determine whether cervical dilatation at the time of placement of patient-requested epidural affects cesarean rates or lengths of labors in actively managed parturients. Methods The charts of 255 women randomized to active management of labor (n = 125) or control protocols (n = 130) were reviewed and stratified to early epidural placement (up to 4 cm cervical dilatation) versus late placement (more than 4 cm). Results Women with early epidural placement had shorter labors than those with late placement (11.6 ± 4.6 versus 13.2 ± 5.6 hours; P = .02). Active management reduced the length of labor compared with controls regardless of epidural timing, with a reduction of 1.4 hours in early epidural placement (10.9 ± 4.7 versus 12.3 ± 4.3 hours; P = .04) and 3.6 hours in those with later placement (11.0 ± 3.6 versus 14.6 ± 6.2 hours; P = .004). Cesarean rates did not vary significantly (early 14.5% versus late 7.9%; P = .21). Early epidural placement did not lengthen the second stage of labor or increase operative vaginal delivery rates. Conclusion Early epidural placement did not affect lengths of labor or cesarean rates and was actually associated with shorter labor compared with late epidural placement. Women managed actively in labor, regardless of timing of epidural placement, had shorter labors than controls. Women with early epidurals have shorter labors than women with late epidurals, and actively managed women have shorter labors than controls, regardless of the timing of epidural placement.