The Risk of Cesarean Delivery with Neuraxial Analgesia Given Early versus Late in Labor

In this randomized trial involving nulliparous women at term, the rate of cesarean delivery was not higher among women who were given intrathecal analgesia early in labor than among those given systemic analgesia early in labor. Women who received intrathecal analgesia early also had better pain control and a shorter time to delivery. The rate of cesarean delivery was not higher among women who were given intrathecal analgesia early in labor than among those given systemic analgesia early in labor. The American College of Obstetricians and Gynecologists recommends that “when feasible, obstetrical practitioners should delay the administration of epidural anesthesia in nulliparous women until the cervical dilatation reaches at least 4.0 to 5.0 cm and that other forms of analgesia should be used until that time.” 1 This recommendation is based on studies that found an association between the initiation of epidural analgesia early in labor and an increased rate of cesarean delivery. 2 , 3 The nature of this association is uncertain. Neuraxial analgesia may directly or indirectly influence the progress of labor. Alternatively, the request for analgesia early in labor may . . .