Risk Of Epidural Anesthesia During LAbor

In discussing the risk of placing an epidural during labor, you explain to your patient that
A) The ACOG (The American Congress of Obstetricians and Gynecologists) recommends that epidural anesthesia in nulliparous women is not recommended until cervical dilation has reached 4 to 5 cm regardless of maternal request.
B) Early epidural anesthesia increases the risk of cesarean section.
C) Epidural anesthesia may increase the rate of vacuum extraction.
D) Epidural anesthesia has no effect on the length of the second stage of labor.
E) Epidural anesthesia is of little help with pain management in early labor.

Answer and Discussion
The answer is
C.  Epidural anesthesia may increase the rate of vacuum extraction.

Epidural analgesia during labor is an effective pain reliever for labor that has become much more commonly used. Despite wide acceptance of this use, the timing of epidural placement remains
controversial, with conflicting reports on the risk for subsequent cesarean deliveries and the length of the latent phase of labor. There are data from several studies suggesting that epidural anesthesia does lengthen the duration of the second stage of labor and may increase the rate of instrumented vaginal deliveries. Previously, ACOG recommended using other forms of analgesia in nulliparous women until they reach dilatation of 4 to 5 cm. However, some institutions did not follow these guidelines for all women in labor, so ACOG released a follow-up report recommending that maternal request is a sufficient indication for epidural analgesia during labor and that it should not be denied on the basis of cervical dilatation.