Archives of Gynecology and Obstetrics

, Volume 298, Issue 1, pp 89–96 | Cite as

The effect of labor epidural analgesia on maternal–fetal outcomes: a retrospective cohort study

  • Qian Wang
  • Sheng-Xing Zheng
  • Yu-Fei Ni
  • Yuan-Yuan Lu
  • Bing Zhang
  • Qing-Quan Lian
  • Ming-Pin Hu
Maternal-Fetal Medicine



To evaluate the impact of labor epidural analgesia on maternal–fetal safety outcomes in a signal Chinese academic medical center.


A single-intervention impact study was conducted at The Second Affiliated Hospital, Wenzhou Medical University. The study period was divided into three phases: (1) baseline phase: from January 1 and June 30, 2009 when no analgesic method was routinely employed during labor; (2) phase-in period: the epidural analgesia was implemented 8 a.m.–5 p.m. during weekdays; and (3) the post—No Pain Labor N’Delivery phase when the labor epidural was applied 24 h a day, 7 days a week, from June 1, 2010 and June 30, 2011. The maternal–fetal safety outcomes of delivery were compared between the different periods.


There were 15,415 deliveries with 42.3% of nulliparous parturients in the 31-month study period. As the primary outcomes, the labor epidural analgesia rate increased from 0 to 57%, the vaginal delivery rate increased, and cesarean delivery rate decreased by 3.5% after full implementation. As the secondary outcomes, the rate of episiotomy and severe perineal injury after the implementation periods were significant decreased. The rate of postpartum oxytocin administration was decreased by 17.8%. No significant difference between the baseline and implementation periods was found in the rate of postpartum hemorrhage, Apgar scores less than 7 at both 1 and 5 min, 7-day mortality, and the overall neonatal intensive care unit admission rate.


Implementation of labor epidural analgesia increased the vaginal delivery rate and use of labor epidural analgesia is safe to parturients and fetus.


Labor epidural analgesia Vaginal delivery Cesarean delivery Oxytocin Postpartum hemorrhage Apgar scores 



We thank Dr. Yun-Hong Zhang (Anesthesia of St. Louis) for helpful revision of the manuscript. L.-Q.H. established the “No Pain Labor & Delivery—Global Health Initiative” program, and L.-Q.H. and J.Z. introduced and implemented the protocol at the study site.

Author contributions

QW: data collection or management, data analysis, and manuscript writing/editing. SXZ: data collection or management and data analysis. YFN: data collection or management and data analysis. YYL: data analysis. BZ: data analysis. QQL: protocol/project development. MPH: protocol/project development.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Antonakou A, Papoutsis D (2016) The effect of epidural analgesia on the delivery outcome of induced labour: a retrospective case series. Obstet Gynecol Int. PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Jones L, Othman M, Dowswell T et al (2012) Pain management for women in labor: an overview of systematic reviews. Cochrane Database Syst Rev 3:Cd009234Google Scholar
  3. 3.
    Anim-Somuah M, Smyth RM, Jones L (2005) Epidural versus non-epidural or no analgesia in labor. Cochrane Database Syst Rev 4:CD000331Google Scholar
  4. 4.
    Ramin SM, Gambling DR, Lucas MJ et al (1995) Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol 86:783–789CrossRefPubMedGoogle Scholar
  5. 5.
    Shnider SM, Abboud TK, Artal R et al (1983) Maternal catecholamines decrease during labor after lumbar epidural anesthesia. Am J Obstet Gynecol 147:13–15CrossRefPubMedGoogle Scholar
  6. 6.
    Lederman RP, Lederman E, Work B, McCan DS (1985) Anxiety and epinephrine in multiparous labor: relationship to duration of labor and fetal heart rate pattern. Am J Obstet Gynecol 153:870–877CrossRefPubMedGoogle Scholar
  7. 7.
    Harkins J, Carvalho B, Evers A et al (2010) Survey of the factors associated with a woman’s choice to have an epidural for labor analgesia. Anesthesiol Res Pract 2010:356789PubMedPubMedCentralGoogle Scholar
  8. 8.
    Le Ray C, Goffinet F, Palot M et al (2008) Factors associated with the choice of delivery without epidural analgesia in women at low risk in France. Birth 35:171–178CrossRefPubMedGoogle Scholar
  9. 9.
    Blondel B, Breart G, Mazaubrun C et al (1997) The perinatal situation in France. Trends between 1981 and 1995. J Gynecol Obstet Biol Reprod 26:770–780Google Scholar
  10. 10.
    Blondel B, Macfarlane A, Gissler M et al (2006) Preterm birth and multiple pregnancy in European countries participating in the PERISTAT project. BJOG 113:528–535CrossRefPubMedGoogle Scholar
  11. 11.
    Fan ZT, Gao XL, Yang HX (2007) Popularizing labor analgesia in China. Int J Gynecol Obstet 98:205–207CrossRefGoogle Scholar
  12. 12.
    Eriksen LM, Nohr EA, Kjaergaard H (2011) Mode of delivery after epidural analgesia in a cohort of low-risk nulliparas. Birth 38:317–326CrossRefPubMedGoogle Scholar
  13. 13.
    Torvaldsen S, Roberts CL (2012) No increased risk of cesarean or instrumental delivery for nulliparous women who have epidural analgesia early in (term) labor. Evid Based Med 17:21–22CrossRefPubMedGoogle Scholar
  14. 14.
    Hu LQ, Zhang J, Wong CA, Cao Q, Zhang G, Rong H, Li X, McCarthy RJ (2015) Impact of the introduction of neuraxial labor analgesia on mode of delivery at an urban maternity hospital in China. Int J Gynaecol Obstet 129:17–21CrossRefPubMedGoogle Scholar
  15. 15.
    Hasegawa J, Farina A, Turchi G et al (2013) Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome. J Anesth 27:43–47CrossRefPubMedGoogle Scholar
  16. 16.
    Nguyen US, Rothman KJ, Demissie S et al (2010) Epidural analgesia and risks of cesarean and operative vaginal deliveries in nulliparous and multiparous women. Matern Child Health J 14:705–712CrossRefPubMedGoogle Scholar
  17. 17.
    Segal S, Su M, Gilbert P (2000) The effect of a rapid change in availability of epidural analgesia on the cesarean delivery rate: a meta-analysis. Am J Obstet Gynecol 183:974–978CrossRefPubMedGoogle Scholar
  18. 18.
    Baumann P, Hammoud AO, McNeeley SG et al (2007) Factors associated with anal sphincter laceration in 40,923 primiparous women. Int Urogynecol J Pelvic Floor Dysfunct 18:985–990CrossRefPubMedGoogle Scholar
  19. 19.
    Dahl C, Kjolhede P (2006) Obstetric anal sphincter rupture in older primiparous women: a case–control study. Acta Obstet Gynecol Scand 85:1252–1258CrossRefPubMedGoogle Scholar
  20. 20.
    Wong CA, Scavone BM, Peaceman AM et al (2005) The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med 352:655–665CrossRefPubMedGoogle Scholar
  21. 21.
    Kotaska AJ, Klein MC, Liston RM (2006) Epidural analgesia associated with low-dose oxytocin augmentation increases cesarean births: a critical look at the external validity of randomized trials. Am J Obstet Gynecol 194:809–814CrossRefPubMedGoogle Scholar
  22. 22.
    Halpem SH, Abdallah FW (2010) Effect of labor analgesia on labor outcome. Curr Opin Anaesthesiol 23:317–322CrossRefGoogle Scholar
  23. 23.
    Goldberg CC, Kallen MA, McCurdy CM, Miller HS (1996) Effect of intrapartum use of oxytocin on estimated blood loss and hematocrit change at vaginal delivery. Am J Perinatol 13:373–376CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnesthesiaThe 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhouPeople’s Republic of China

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