Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Established Evidence Results

Results for Keyword:

Below are articles that support specific interventions to advance MCH National Performance Measures (NPMs) and Standardized Measures (SMs). Most interventions contain multiple components as part of a coordinated strategy/approach.

You can filter by intervention component below and sort to refine your search.

Start a New Search

Displaying records 1 through 3 (3 total).

Dickinson JE, Paech MJ, McDonald SJ, Evans SF. The impact of intrapartum analgesia on labour and delivery outcomes in nulliparous women. Aust N Z J Obstet Gynaecol. 2002;42(1): 59-66.

Evidence Rating: Moderate Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Continuity of Care (Caseload), Epidural Analgesia, Midwifery

Intervention Description: To determine if nulliparous women intending to have epidural analgesia have a similar labour profile and delivery outcome to women who intend to have their labour managed using alternative forms of pain relief.

Intervention Results: Rate of CS lower in CMS group vs. epidural group (14.2% vs. 17.2%; p>0.05)

Conclusion: The duration of labour was shorter in the CMS group compared with EPI (10.7 hours (inter quartile (IQ) 7.0,15.2) versus 11.4 hours (IQ 8.2,15.2), p = 0.039). The median duration of the first stage was 8.9 hours (IQ 6,12.5) versus 9.5 hours (IQ 7,12.7) (p = 0.069), and the median duration of the second stage was 1.33 hours (IQ 0.6,2.5) versus 1.48 hours (IQ 0.77,2.6) (p = 0.034). The requirement for oxytocin augmentation in spontaneous labour was 39.8% CMS versus 46.2% EPI (p = 0.129). There was no significant difference in the caesarean section rates. The need for any operative delivery was significantly lower in CMS (43.9% CMS versus 51.5% EPI, p = 0.019).

Study Design: RCT

Setting: 1 tertiary obstetric institution

Population of Focus: Nulliparous women who gave birth between May 1997 and October 1999

Data Source: Not specified

Sample Size: Total (n=992) Intervention (n=499) Control (n=493)

Age Range: Not Specified

Access Abstract

Eriksen, LM, Nohr EA, Kjaergaard H. Mode of delivery after epidural analgesia in a cohort of low-risk nulliparas. Birth. 2011;38(4):317-326. doi:10.1111/j.1523-536X.2011.00486.x

Evidence Rating: Moderate Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Epidural Analgesia

Intervention Description: The aim of this study was to explore associations between epidural analgesia and mode of delivery.

Intervention Results: Of the total cohort, 21.6 percent required epidural analgesia, 8.7 percent had emergency cesarean section, and 14.9 percent had vacuum extraction. Women with epidural analgesia had a higher risk of emergency cesarean section (adjusted OR: 5.8; 95% CI: 4.1-8.1), and vacuum extraction (adjusted OR: 1.7; 95% CI: 1.3-2.2). In a subgroup of the cohort with a very low overall risk of cesarean section, 3.4 percent had emergency cesarean section and an increased risk of emergency cesarean section was also found in this group (adjusted OR: 3.5; 95% CI: 1.5-8.2).

Conclusion: In nulliparous women of a very low-risk population, use of epidural analgesia for labor pain was associated with higher risks of emergency cesarean section and vacuum extraction.

Study Design: Prospective cohort

Setting: 9 labor wards

Population of Focus: Spontaneously laboring nulliparous women who gave birth after recruitment between May 2004 and July 2005

Data Source: Not specified

Sample Size: Total (n=2,721) Intervention (n=588) Control (n=2,133)

Age Range: Not Specified

Access Abstract

Eriksson SL, Olausson PO, Olofsson C. Use of epidural analgesia and its relation to caesarean and instrumental deliveries-a population--based study of 94,217 primiparae. Eur J Obstet Gynecol Reprod Biol. 2006;128(1-2):270-275. doi:10.1016/j.ejogrb.2005.10.030

Evidence Rating: Emerging Evidence

Intervention Components (click on component to see a list of all articles that use that intervention): Epidural Analgesia, PROVIDER/PRACTICE

Intervention Description: To investigate the association between epidural analgesia for labour-pain relief and mode of delivery.

Intervention Results: There was no clear association between frequency of epidural block and caesarean section and instrumental delivery, respectively. Delivery units with the lowest (20-29%) and the highest (60-64%) relative frequencies of epidural block had the lowest proportion of caesarean section (9.1%). For the other groups the proportion varied between 10.3 and 10.6%. Instrumental deliveries were most common, 18.8%, in delivery units with 50-59% frequency of epidural block use. The lowest incidence (14.1%) was in units using epidurals in 30-39% of cases. In the other groups (20-29, 40-49 and 60-64%) the proportion varied between 15.3 and 15.7%.

Conclusion: This investigation shows no clear association between epidural use and caesarean section or instrumental delivery, indicating that there is no reason to restrict the epidural rate to improve obstetric outcome.

Study Design: Retrospective cohort

Setting: 52 delivery units (all)

Population of Focus: Nulliparous women who gave birth, excluding elective cesarean deliveries, between 1998 and 2000

Data Source: Not specified

Sample Size: n=94,217

Age Range: Not Specified

Access Abstract

The MCH Digital Library is one of six special collections at Geogetown University, the nation's oldest Jesuit institution of higher education. It is supported in part by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under award number U02MC31613, MCH Advanced Education Policy with an award of $700,000/year. The library is also supported through foundation and univerity funding. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.