WESTPORT, CT (Reuters Health) Aug 13 - Women who receive an epidural to reduce pain during childbirth do not have an increased risk of Cesarean section, government researchers report.

"We found that the epidural does not increase the risk of a C-section," lead author Dr. Jun Zhang, an investigator at the National Institute of Child Health and Human Development, told Reuters Health. The epidural is safe and women shown have one if they really need it, he added.

Previous research found a much higher risk of C-section delivery following the use of an epidural. However, conclusive studies have been difficult to conduct.

Dr. Zhang's team was able to study the effects of epidural use thanks to a procedural change at Tripler Army Medical Center in Oahu, Hawaii. In October 1993, the base changed its policy to allow epidurals upon demand, increasing the percentage of women who used them from only 1% to more than 70% annually.

Prior to the change, the majority of women received intravenous narcotics, a less effective but cheaper method of reducing pain that is not thought to adversely affect labor and delivery, Dr. Zhang said.

No other significant changes occurred in the medical facility during that time and the women in the two groups were not significantly different. Because medical care is free to all military personnel and their relatives, financial considerations also played no factor in the use of epidurals, Dr. Zhang noted.

The investigators compared 507 women who gave birth before October 1, 1993, with 581 women who gave birth after October 1, 1995.

Among women in the later group, 84% had epidurals, while only 1% in the earlier group did. However, women in the later group were no more likely to have a C-section than were women who gave birth before the policy change on epidurals, according to the report in the American Journal of Obstetrics and Gynecology.

However, women in the later group tended to be in labor longer. The increased length--25 minutes, on average--came during the second stage of labor, when the infant is pushed through the birth canal.

However, this may not solely have been because the mother became less able to push after an epidural, Dr. Zhang said. Physicians may have been more inclined to let the labor proceed naturally knowing that the woman's pain was under control.

The research team also found that women in the later group were less likely to need invasive forceps or other instruments to aid delivery.

"I think it's reassuring," Dr. Zhang said, "that an epidural does not have detrimental effects on labor and delivery."

Am J Obstet Gynecol 2001;185:128-134.

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