Original Article

Labor Epidurals Improve Outcomes for Babies of Mothers at High Risk for Unscheduled Cesarean Section†

¹Departments of Medicine, Pediatrics, and Preventive Medicine and Biometrics (K. A. C. S., H. K., E. C., G. S. M.), The Uniformed Services University of the Health Sciences, Bethesda, MD

²Forensic Medical Advisory Service (E. S., M. L.), Rockville, MD

Correspondence to: Gregg S. Meyer, MD, MSc, Agency for Healthcare Research and Quality, Center for Quality Measurement and Improvement, 2101 East Jefferson Street, Suite 502, Rockville, MD 20852

^†Disclaimer: The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army, Department of the Air Force, the Department of Defense, or the Department of Health and Human Services.

Abstract

CONTEXT: Epidural placement for labor in the general population of laboring women is associated with increased incidence of operative deliveries, prolongation of labor, and may be associated with an increased cesarean section rate. The risks and benefits associated with epidural placement for labor in the subpopulation of mothers at high risk for cesarean section have not been studied.

OBJECTIVE: To determine if a population of mothers and babies at high risk for cesarean section will have improved outcomes with labor epidural placement.

DESIGN: A decision and cost analysis examining epidural placement for labor on a population of women who are at high risk for unscheduled cesarean section and may benefit from scheduled cesarean section as determined by threshold analysis was performed. Outcomes and probabilities were determined through analysis of the Department of Defense's 1996 National Quality Management Program (NQMP) Birth Product Line data set containing more than 7000 deliveries. Outcomes were defined using variables comprised of all documented conditions that occurred during the peripartum and neonatal hospitalizations. The 1997 NQMP data set was used to validate the results.

SETTING: Military Treatment Facilities throughout the United States and abroad and civilian facilities in the United States providing care to military dependents.

PATIENT POPULATION: Active duty and dependent pregnant women and babies.

RESULTS: About 8% of mothers in this patient population were found to be at high risk for cesarean section. The decision and cost analyses showed that babies of the high risk mothers who received epidurals for labor had better clinical outcomes (p<0.05) and the procedure was cost neutral (p=0.23). The procedure did not increase the frequency of cesarean section, and there was no effect on maternal outcomes scores. These results were confirmed by the validation study.

CONCLUSIONS: There is a sizable subpopulation of women at high risk for cesarean section whose babies may have better outcomes with epidural placement with no sacrifice in maternal outcomes or costs. Journal of Perinatology 2001; 21:178-185.

April/May 2001, Volume 21, Number 3, Pages 178-185

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