Epidural Analgesia in the Latent Phase of Labor and the Risk of Cesarean Delivery

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Abstract
NEURAXIAL analgesia is the most effective treatment available for pain control during labor and delivery, and it is a preferable method because it can provide more effective pain relief compared with nonneuraxial pharmacological analgesia.1 However, optimal timing of epidural analgesia (EA) has been a controversial issue and how early in the latent phase of labor can women benefit from epidural is still debated. Before 2002, clinical guidelines recommended that the administration of EA in nulliparous women should be delayed until the cervical dilation reaches at least 4.0 to 5.0 cm and that other forms of analgesia should be used until that time.2 In 2005, Wong et al. published a paper clarifying that pain relief early in labor with neuraxial analgesia at the cervix dilated 2.0 cm or more does not increase the risk of Cesarean delivery3; this combined with Ohel’s report4 contributed to the change in recommendation on EA in labor pain control from the American College of Obstetricians and Gynecologists in June 2006.5

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