Impey L, MacQuillan K, Robson M.  Am J Obstet Gynecol 182; 358-63, 2000

Reviewer: Fred Spielman, MD

An interesting study from the National Maternity Hospital in Dublin, where the epidural utilization rate rose from 10% in 1987 to 43% in 1992, and 57% in 1994. The investigators determined the rates of cesarean delivery and instrumental vaginal delivery in the first 1000 nuliparous women who delivered in each of these years. There was no change in either parameter despite a five-fold increase in the epidural rate. The authors also suggest that epidural analgesia can be initiated early in the second stage with little increased risk of instrumental delivery if active management principles are followed.