Epidural analgesia side effects, co-interventions, and care of women during childbirth: A systematic review

Birth outcomes associated with interventions in labour amongst low risk women: A population-based study

“…We also note that where an attempt at vaginal birth is indicated the practice of electively adding oxytocin infusions appears to have become 'routine' once an epidural is in situ. 21,23,27 Mode of birth was recorded as: unassisted vaginal birth, instrumental birth (which included both vacuum extraction and forceps); or cesarean section with labour (we excluded cesarean section where there was no record of the onset of labour. )…”

“…In particular, long-term follow-up of infants in relation to feeding and mother-infant interactions is very scarce. 21,23,41 Published reviews have found that an epidural block is likely to provide more effective pain relief during labour than alternative pharmacological methods 21 ; it does not increase the incidence of long-term backache 42 ; it is associated with an increased rate of induction or augmentation of labour, 23 and the use of antibiotics for maternal fever. 43 Studies have also shown that epidurals may alter the dynamics of labour 21,32,44 maternal temperature regulation 21,23 and result in increased rates and costs of operative birth.…”

“…21,23,41 Published reviews have found that an epidural block is likely to provide more effective pain relief during labour than alternative pharmacological methods 21 ; it does not increase the incidence of long-term backache 42 ; it is associated with an increased rate of induction or augmentation of labour, 23 and the use of antibiotics for maternal fever. 43 Studies have also shown that epidurals may alter the dynamics of labour 21,32,44 maternal temperature regulation 21,23 and result in increased rates and costs of operative birth. 21,23,41,[45][46][47] They are associated with important other maternal complications that require further intervention such as intravenous fluids to attenuate the decrease in maternal blood pressure 23,48 and catheterization to avert urinary retention 21,23 ; and continuous electronic fetal heart rate monitoring throughout the duration of labour.…”

“…43 Studies have also shown that epidurals may alter the dynamics of labour 21,32,44 maternal temperature regulation 21,23 and result in increased rates and costs of operative birth. 21,23,41,[45][46][47] They are associated with important other maternal complications that require further intervention such as intravenous fluids to attenuate the decrease in maternal blood pressure 23,48 and catheterization to avert urinary retention 21,23 ; and continuous electronic fetal heart rate monitoring throughout the duration of labour. 23,27,41,49 …”

“…20 Despite concern over the high rate of operative birth in many resource rich nations particularly amongst low risk healthy women, the obstetric antecedents of operative birth are poorly described and as yet there is no clear consensus in the literature whether or not the rates of cesarean section are associated with unintended side effects of the use of epidurals. [21][22][23][24] Although a population-based cohort study cannot determine causative relationships, it can observe associations that occur between interventions in labour and subsequent birth outcomes. Our aim was to determine the association between interventions introduced in labour with the interventions in the birth process amongst women of low medical risk and to ascertain the current status of unassisted spontaneous vaginal birth in relation to obstetric interventions experienced during labour amongst these low risk women.…”