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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Prospective Studies Show Epidurals Cause Cesarean Sections

In referencing Thorp, I meant to reference his meta-analysis of studies about epidurals (Birth, volume 23, no. 2, June 1996) and not just his own 1989 and 1993 studies.

My point was that prospective trials are being done (not just by Thorp) and that they are all showing from 2 to 4 times greater cesareans for epidurals compared to narcotic analgesia. Imagine what the difference would be if the control group were mothers having labor support, doulas, and/or home births!

I wanted to summarize for you the prospective studies.

Prospective Clinical Trials Investigating the Association between Epidural Analgesia and Cesarean Birth Rates by Randomizing Women to a Narcotic versus an Epidural Group:

Reference and Parity      Sample Size      Relative Risk of Cesarean
                                              Birth with Epidural
                                              Analgesia (95% CI)

1.  Combined                      111          2.8  (0.8-10.0)
2.  Nulliparous                    93         11.4  (5.8-16.9)*
3.  Nulliparous**                 693          2.6  (1.5-4.3)*
     Parous**                     637          3.8  (1.3-11.0)*
     Combined***                  869          2.3  (1.3-4.0)*
All three prospective
     trials combined             1073          2.5  (1.6-4.0)****,*

* Relative risk is statistically significant at least at p < 0.05
** This represents the odds ratio for all women in the study adjusted by
multivariate logistic regression analysis.
*** The cesarean birth rate was significantly greater (p = 0.002) in the
epidural group (9%, 39/432) compared with the narcotic group (4%, 17/437).
**** Comparison of the proportions by Mantel-Haenszel yields a chi-squared of
18.1 and a p-value of 0.00003.

1. Phillipsen T, Jensen NH. Epidural block or parenteral pethidine as analgesic on nulliparous labor; a randomized study concerning progress in labour and instrumental deliveries. Eur J Obstet Gynecol Reprod Biol 1989; 30:27-33.
2. Thorp JA, Hu DH, Albin RM. The effect of intrapartum epidural analgesia on nulliparous labor: A randomized prospective trial. Am J Obstet Gynecol 1993; 169:851-858.
3. Ramin SM, Gambling DR, Lucas MJ. Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol 1995; 86:783-789.