THE EFFECT OF LUMBAR EPIDURAL ANALGESIA ON THE RATE OF CERVICAL DILATATION AND THE OUTCOME OF LABOUR OF SPONTANEOUS ONSET

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Abstract
A study of 1955 spontaneous labors is presented relating progress and outcome to the presence of a lumbar epidural block in 282 of these patients and to the need for oxytocin augmentation in 427. Graphs for cervical dilatation starting at admission to hospital were constructed for normal and dysfunctional spontaneous onset labors. Patients requiring labor augmentation had a lesser cervical dilatation on admission to hospital, a longer 1st stage, more instrumental deliveries, more cesarean sections and a greater number of low Apgar score babies. An epidural block had no effect on either the duration of 1st stage or the cervical dilatation rate but was associated with a 20-fold increase in rotational forceps delivery and no increase in cesarean section rate. With an epidural block there was no increase in the number of babies with cerebral irritation or low Apgar scores and there was significant improvement in the Apgar scores of babies of mothers in augmented dysfunctional labor who had an epidural block. The incidence of rotational forceps delivery in patients with an epidural block could be reduced with safety by allowing such patients to have a longer 2nd stage before considering interference purely for delay.