An Association Between Severe Labor Pain and Cesarean Delivery
ABSTRACT The relationship between epidural analgesia and cesarean delivery remains controversial. Several studies have documented an association, although others have not. This inconsistency may result from an association between severe labor pain and dystocia. We hypothesized that dystocia causes severe labor pain, such that more epidural medication is required to maintain comfort. We examined the relationship between labor outcome and severe pain, defined by the number of supplemental epidural boluses. We retrospectively reviewed the anesthesia records of 4493 parturients who received small-dose labor epidural analgesia. An independent association was found between operative delivery and maternal age, body mass index, nulliparity, fetal weight, induction of labor, and the number of boluses required during labor. By using multivariate analysis, the odds ratio of cesarean delivery among women who required at least three boluses was 2.3 compared with those who required two boluses or less. No association was found between the concentration of bupivacaine in the epidural infusion and operative delivery. Because women with cesarean deliveries appeared to have more pain, degree of labor pain may be a confounding factor in studies examining epidural analgesia and outcome. Implications: This is a retrospective observational study demonstrating an association between labor pain and cesarean delivery. Our results provide an alternative explanation of why epidural analgesia is associated with cesarean delivery.
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ABSTRACT: The aim of the anaesthesia for instrumental delivery is to provide optimal operation conditions for the obstetrician, appropriate maternal comfort, altogether with safety for the mother and her fœtus. The type and location for this intervention are chosen individually for each case according to the indication, the risk of caesarean section and the local specificities. The general safety recommendations for obstetric anaesthesia apply in every case. Since an epidural analgesia is often already working, this type of anaesthesia is the most frequently used for the extractions. A spinal anaesthesia is a logical choice where an epidural in sot yet working. The pudendal block is a second line choice and the general anaesthesia remains as the last alternative in acute emergencies, in cases of failed regional anaesthesia or when the mother refuses any other anaesthesia despite proper information or proves unable to cooperate.Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2008; 37(8). DOI:10.1016/S0368-2315(08)74764-1 · 0.62 Impact Factor
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ABSTRACT: Since 1999, the rate of cesarean deliveries has increased considerably in Utah. We examined the relationship between cesarean deliveries and newborn injury among 171,114 women across the state of Utah during the years 2001-2004, using linked birth certificate and hospital discharge data. During this four-year period, there were 958 newborn injuries, yielding a rate of 6 per 1,000 live births. We found that cesarean deliveries, with or without complications, do not increase the risk of neonatal injury in Utah, particularly after the effect of other factors is statistically controlled. Risk of neonatal injuries was greater for Non-Ob/Gyn birth attendants, births with Emergency Department as a source of admission, urban hospitals, and teaching hospitals, but lower for mothers who delivered at a hospital outside their county of residence. Important policy and research implications of these findings are discussed.