1. Home>
2. Specialties>
3. Women's Health>
4. Summary and Comment

Epidural vs. Combined Spinal-Epidural Analgesia

Epidural analgesia is commonly used during childbirth, but there is concern about whether it leads to more C-sections among nulliparous women. This study randomized 761 nulliparous women to either continuous epidural analgesia or a combination of spinal and epidural analgesia that maintains motor function and allows ambulation. All patients were in spontaneous labor and had requested epidurals.

There were no significant differences between the analgesia groups in the C-section rate, incidence of dystocia, maternal or fetal complications, or patient satisfaction. More women using the combination analgesia developed pruritus and requested additional anesthetic. Risk factors associated with dystocia and C-section included epidural administered at less than 4 cm of dilation (odds ratio 2.2; p<0.001) or with the fetal vertex at a negative station (OR, 2.5; p<0.001), and inability to walk. Women in the epidural-only group had more instrumental deliveries.

Comment: This study did not show significantly better outcomes using spinal-epidural analgesia as compared with continuous epidural in nulliparous women, but the spinal-epidural combination is safe and allows women to walk. As pointed out in an editorial, the authors could not assess whether the epidurals themselves led to C-section, or whether women in early labor who ask for epidurals are more likely to have dysfunctional labor that would lead to a C-section.

— W Levinson

Published in Journal Watch Women's Health January 1, 1998

Citation(s):

Nageotte MP et al. Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. N Engl J Med 1997 Dec 11 337 1715-1719.

• Original article (Subscription may be required)
• Medline abstract (Free)

Birnbach DJ. Analgesia for labor. N Engl J Med 1997 Dec 11 337 1764-1766.

• Original article (Subscription may be required)
• Medline abstract (Free)