Segal S, Su M, Gilbert P. Am J Obstet Gyncol 183: 974-978, 2001

Reviewed by: F. Spielman, MD

The limitations of studies investigating the effects of epidural analgesia on cesarean section rates are well known. Retrospective studies are plagued by slection bias, and the results of prospective studies are frequently confused by crossover between groups. A sentinel event study that investigates the change in cesarean delivery rates after a rapid change in the availability of epidural analgesia avoids those difficulties.

The authors perfomed a meta-anlysis of nine sentinel event studies that looked at over 37,000 patients. Their analysis demonstrated that a sudden change in the availability of epidural analgesia had no effect on C/S rates. In conclusion it appears that obstetric factors play a far greater role in the C/S rate than the use of epidural analgesia does.