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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 08 Jan 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Obstetricians and epidural analgesia. Letter to the Editors. American Journal of Obstetrics and Gynecology. 1994;170(6):1161.

Author(s) :

Thorp JA.

Year of publication :


URL(s) :…

Résumé (français)  :

Abstract (English)  :

Farabow et al. should be congratulated on their retrospective analysis of a 20-year experience with epidural analgesia administered by obstetricians (Farabow WS, Roberson VO, Maxey J, Spray BJ. A twenty-year retrospective analysis of the efficacy of epidural analgesia-anesthesia when administered and/or managed by obstetricians. AM J OBSTET GYNECOL 1993;169:270-8).

Reviewing >31,000 births at their institution in the last 20 years was certainly a monumental task. The obstetricians probably have provided safe and effective epidural services over the last 20 years. However, the design of this study does not provide convincing evidence for this conclusion. Review of a database consisting of “delivery room logs,” some of which are 20 years old, is unreliable. Many epidural complications occurring before, during, and after delivery would not necessarily be documented in the delivery room log. The authors should be encouraged to prospectively collect purposeful data regarding their institution’s epidural experience.

In the authors’ institution, as in the rest of the United States, it remains largely unrecognized that epidural analgesia has been a major contributor to the cesarean section “epidemic” in the last 20 years. These authors observed the cesarean section rate to increase from 5% in 1972 to 27% in 1989. During the same time the use of intrapartum epidural analgesia rose to 60% of all deliveries, an equivalent rate of >80% in nulliparous labors. Because vaginal birth after cesarean delivery was rare in the 1970s and 1980s, primary cesarean section for dystocia rapidly accelerated the total cesarean section rate because of the rising contribution of repeat cesarean section. Thus epidural anesthesia caused both the primary and repeat cesarean section rates to rise.

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Argument (français) :

Argument (English):

Argumento (português):

Keywords :

➡ c-section/caesarean ; evidence-based medicine/midwifery ; vaginal birth after caesarean ; dystocy ; instrumental delivery ; epidural ; forceps delivery ; vacuum extraction (ventouse)

Author of this record :

Cécile Loup — 08 Jan 2004

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