The effect of epidural analgesia on the second stage of labor.

A retrospective review of 202 randomly selected records of parturient labors examined the relationship between cervical dilation at epidural analgesia administration and length of the second stage of labor. The epidural group received bupivacaine 0.11% or 0.125% with sufentanil 1 to 2 micrograms/mL using a Bard Patient Controlled Anesthesia II pump. Labor management and outcomes were compared with a nonepidural group who chose unmedicated childbirth, intravenous narcotics, or pudendal block. A significant inverse correlation was found between cervical dilation at epidural administration and second-stage length in labors that did not use oxytocin. However, linear regression explained only 13.5% of the variance, leaving 86.5% unexplained. In labors in the epidural group that used oxytocin, cervical dilation at epidural administration was not correlated with second-stage length. The epidural group experienced a significantly longer mean length of the second stage. Labors in the epidural group were 3.5 times more likely to have oxytocin induction or augmentation and 4.5 times more likely to experience instrument-assisted delivery. There were no significant differences in Apgar scores between the two infant groups.

Maternal upright posture and mobility in labor--a review.

There has been a relatively recent interest in alternative birthing techniques, including increased maternal mobility during labor. This literature review was pursued to evaluate the effect of upright maternal posture and ambulation on the first stage of labor. Although previous reviews frequently assume that maternal ambulation speeds labor progress, the data presented in this review are not conclusive as to whether the upright maternal posture or ambulation during the first stage of labor shortens labor length or improves fetal outcome. However, it is clear that ambulation in labor is not harmful either to the mother or fetus. In addition, many investigators have reported that mobility in labor results in greater maternal comfort and ability to tolerate labor and decreased use of anesthesia and analgesia. Thus, acceptance of mobility in labor by patients and staff is generally reported. This information can serve as a guide to clinical management. However, there is a need for further analysis of the effect of maternal ambulation during labor, and specific suggestions for research are presented.