Z Geburtshilfe Neonatol 2015; 219 - FV06_6
DOI: 10.1055/s-0035-1566489

Association between analgesia and labour duration as well as mode of birth

D Zondag 1, MM Gross 1, S Grylka-Baeschlin 1, A Petersen 1
  • 1Hannover Medical School, Midwifery Research and Education Unit, Hannover, Germany

Objective: No research has been done on the combination of epidural and opioid analgesia during labour with respect to sequence and timing. This study investigates the association of analgesia, opioids or epidural or the combination of both with labour duration and spontaneous birth in nulliparous women.

Methods: A secondary data analysis of an existing cohort study was performed and included nulliparous women (n = 2074). Durations of total labour and first and second labour stage were calculated with Kaplan-Meier estimation for the four different study groups: no analgesia (n = 620), opioid analgesia (n = 743), epidural analgesia (n = 482), combined application (n = 229). Labour duration was compared by Cox-regression while adjusting for confounders and censoring for operative births. Logistic regression was used to investigate association with the chance on a spontaneous birth.

Results: Most women received first opioid analgesia in case of combined application. Women with no analgesia had the shortest duration of labour (log rank p < 0.001) and highest chance of a spontaneous birth (p < 0.001). If analgesia was administered, women with opioids had a shorter first stage (p < 0.001), compared to women with epidural (p < 0.001) or women with combined application (p < 0.001). Women with opioids had an increased chance to reach full cervical dilation (p = 0.015).

Women with epidural analgesia (p < 0.001) and women with combined application (p < 0.001) had a prolonged second stage and decreased chance on spontaneous birth compared to women without analgesia. No difference was found for women with opioids in relation to duration of the second stage (p = 0.884) or for a spontaneous birth (p = 0.077).

Conclusion: Opioid and epidural analgesia were both associated with a prolonged first stage of labour. Epidural analgesia or its combination with opioid analgesia were associated with a prolonged second stage and a decreased chance of spontaneous birth.