The Influence of Analgesia on Labor—Is it Related to Primary Cesarean Rates?

Multiple observational studies have reported an association between neuraxial (epidural, spinal, or combined spinal–epidural) labor analgesia and cesarean delivery. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of cesarean delivery. Additionally, the review will discuss whether the timing of initiation of analgesia or the specific type of neuraxial analgesia influences mode of delivery. Finally, the issue of external validity of published trials will be discussed.