Article Text

Download PDFPDF
A Reevaluation of the Association Between Instrument Delivery and Epidural Analgesia
  1. Joy L. Hawkins, M.D.*,
  2. Kenneth R. Hess, M.S.,
  3. Martha A. Kubicek, R.N.*,
  4. Thomas H. Joyce III, M.D.* and
  5. Dean H. Morrow, M.D.*
  1. *Department of Anesthesiology, Baylor College of Medicine, Houston, Texas
  2. Department of Surgery, Baylor College of Medicine, Houston, Texas
  1. Reprint requests: Thomas H. Joyce, M.D., Department of Anesthesiology, University of Cincinnati, 231 Bethesda Avenue, Cincinnati, OH 45267-0531.


Background and Objectives Over 100 papers in the medical literature suggest pro or con that epidural analgesia is associated with an increase in the incidence of instrument delivery. This two-component study was performed to evaluate the influence of epidural labor analgesia on the incidence of instrument delivery.

Methods Component 1 was a retrospective analysis of the medical records of 14,804 mothers having a vaginal delivery before and after implementation of an active epidural service. Component 2 was a case control study designed to determine factors, in addition to epidural analgesia, associated with an increase in instrument delivery. In component 2 11 factors describing maternal, fetal, anesthetic, and obstetric factors were analyzed for each of 609 consecutive patients having an instrument delivery and 246 controls having a spontaneous vaginal delivery.

Results In component 1, despite a tenfold increase in the use of epidural analgesia, there was a similar association between epidural use and instrument delivery in both time periods. Additionally, the epidural-forceps association was twice as strong for parous patients as for nulliparous patients (odds-ratios 9.74 and 4.52, respectively). In component 2, five factors were significantly (P > .0001) associated with instrument delivery conclusions.

Conclusions While epidural analgesia was one factor, the others were gestational age >41 weeks, a second stage of labor >2 hours, an occiput posterior or transverse fetal position, and previous cesarean section. These four factors are individually and independently associated with an increase in the incidence of instrument delivery independent of epidural use.

  • anesthesia
  • obstetric
  • anesthetic technique
  • epidural forceps

Statistics from


  • Presented in part at the 64th Congress of the International Anesthesia Research Society, Honolulu, Hawaii, March 1990; and the 15th Annual Meeting of the American Society of Regional Anesthesia, Orlando, Florida, March 1990.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.