82: The second stage of labor and epidural use: a larger effect than previously suggested

Article Outline

• Objective
• Study Design
• Results
• Conclusion
• Copyright

Back to Article Outline

Objective 

To examine the length of labor with and without an epidural to estimate the appropriate adjustment of non-epidural labor curves.

Back to Article Outline

Study Design 

Retrospective cohort study of 38,273 laboring women at a single institution. Median lengths of the first and second stages of labor were examined stratifying by epidural use and parity. Comparisons were made with the Kruskal-Wallis test.

Back to Article Outline

Results 

We found that the median length of labor was statistically significantly longer in the setting of epidural for both nulliparous and multiparous women (p<0.001). Interestingly, the 95%iles for the second stage of labor were more than two hours longer for nulliparous women and almost three hours longer for multiparas (p<0.001).

• 
  • View Large Image
  • Download to PowerPoint

• Table: Median and 95%ile of the First and Second Stage of Labor

Back to Article Outline

Conclusion 

While recommendations for intervention during the second stage of labor have been made based upon a one-hour difference in the setting of epidural use, it appears that the 95%ile is actually two to three hours longer with an epidural. The length of labor needs further study in the setting of modern obstetric practice to delineate appropriate versus unnecessary intervention.