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Length of the Second Stage of Labor: What Is the Effect of an Epidural?

INTRODUCTION: We evaluated the length of the second stage of labor in women with and without epidural analgesia to estimate the effect of an epidural. METHODS: This was a retrospective cohort study of 4,605 women without a history of cesarean delivery at a single community hospital. Length of the second stage of labor with and without an epidural was analyzed for nulliparous and multiparous women by median and 95th percentile. Data were stratified by parity. Subanalysis was performed for women with vaginal delivery. Statistical analysis was performed by Wilcoxon rank-sum test. RESULTS: Nulliparous women with epidural had second stage median length 1 hour longer than women without epidural (105 compared with 42 minutes). However, the 95th percentile for second stage length in nulliparous women with epidural compared with without was almost 2 hours longer (338 compared with 221 minutes). In multiparous women, median second stage length with epidural was 16 minutes longer than without (26 compared with 10 minutes), but the 95th percentile was 112 minutes longer (168 compared with 56 minutes). When analyzing for women who had achieved vaginal delivery, the difference in 95th percentile with and without epidural was 95 minutes for nulliparas and 101 minutes for multiparas (Table 1). All comparisons had P value <.001. Table 1 Second Stage Length* CONCLUSIONS: Even among women who achieve vaginal delivery, the increase in length of second stage in women who received an epidural was greater than 90 minutes in both nulliparous and multiparous women. These data should inform guidelines surrounding the management of the second stage of labor.