Intended for healthcare professionals

Letters

Early epidurals increase caesarean rate, meta-analysis shows

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7494.790-b (Published 31 March 2005) Cite this as: BMJ 2005;330:790
  1. Michael C Klein (mklein{at}interchange.ubc.ca), physician
  1. BC Women's Hospital, Vancouver, British Columbia, Canada V6H 3VJ

    EDITOR—The study reported by Mayor in her news item uses the term “neuraxial analgesia” and claims that early epidurals do not increase the rate of caesarean deliveries.1 2 This is confusing as the study was not of early epidural analgesia, and the oxytocin augmentation rate of 75% at first analgesia makes for lack of generalisability.

    The claim that women need not worry that early epidurals will lead to increased caesareans is false.3 This trial was about two methods of helping women with pain in early labour. In the so called epidural arm, on their first request for analgesia, women received intrathecal fentanyl, and in the narcotic arm, hydromorphone. On their second request, almost two thirds of women in both arms were 4 cm or more dilated. In the intrathecal “epidural” arm, they received low dose epidurals; in the narcotic arm, hydromophone.

    This trial, as others that have contributed to the Cochrane meta-analysis,4 5 showed no increase in caesareans in the presence of epidural analgesia, but does not acknowledge that most women were in active labour at randomisation, when most will do well. Wong et al,2 like Sharma et al, the major contributors to the Cochrane meta-analysis,4 have shown only that when women's pain in the latent phase is managed with intrathecal, narcotic, or other pharmacological or non-pharmacological means, an epidural in the active phase of labour does not increase the rate of caesareans.

    The role of an early epidural in contributing to increases in caesarean rates has yet to be studied in an randomised controlled trials, but the sensitivity analysis in the Cochrane meta-analysis, after removing late randomisation studies, shows that early epidurals to more than double caesarean rates.

    Footnotes

    • Competing interests None declared.

    References

    1. 1.
    2. 2.
    3. 3.
    4. 4.
    5. 5.