This week the U.S. Centers for Disease Control National Center for Health Statistics published a report on the use of epidurals, spinal blocks and combined spinal/epidurals for pain relief in labor for women who had a vaginal birth in 2008. Based on data collected from 27 states that track the use of anesthesia for labor, six out of ten women with a singleton birth received an epidural or spinal anesthesia.
Labor anesthesia rates ranged from 21.9 percent in New Mexico and 42.5 in California to 78.2 percent in Kentucky. Women who received epidural/spinal anesthesia during labor but ultimately had a cesarean delivery were excluded and according to the study’s authors the data likely underestimates the proportion of all labors that involve epidural/spinal anesthesia.
More than three out of five women (63.4 percent) whose births were attended by a medical doctor or a doctor of osteopathic medicine (62.5 percent) received epidural/spinal anesthesia compared with less than one in two women attended by a certified nurse midwife (49.8 percent).
Although the use of epidural or spinal anesthesia is very effective at reducing labor pain, the report acknowledges that women who use this form of pain relief are more likely to be at risk for several complications:
- Increased risk of instrumental delivery (forceps or vacuum)
- Fetal malposition
- A longer second stage of labor
- Fetal distress (compared with women who receive opiates intravenously or by injection)
- Severe headache
- Maternal hypotension
- Maternal fever, and
- Urinary retention
Women in the U.S. have limited access to other non-pharmacological methods of pain relief that are not associated with these risks.
Among the three different types of vaginal delivery (spontaneous, forceps, and vacuum), more than one-half of women (60.0 percent) who had spontaneous vaginal births received epidural/spinal anesthesia during labor, compared with 83.8 percent of women who had a forceps delivery and 77.3 percent with a vacuum extraction.
The use of anesthesia for labor varied by age, race, educational level, and parity. Women under age 20 (nearly 64 percent) were more likely to have anesthesia than women 35-39 years of age (59 percent). Women over 40 were least likely (55.3 percent) to receive epidural/spinal anesthesia. Use of anesthesia for labor also differed by race. Non-Hispanic White women were the most likely to received epidural/spinal anesthesia (68.6 percent) compared with 62.1 percent of black women and 61.8 percent of Asian women.
Women with at least a master’s or doctoral degree (70.1 percent) were twice as likely to receive epidural/spinal anesthesia as women with an 8th grade education (33.8 percent). Women who gave birth for the first time (68.1 percent) were more likely to receive regional anesthesia than women giving birth to their second or higher child (57.3 percent).
The CDC reports large state differences in the percentage of mothers who receive epidural/spinal anesthesia. The differences may be influenced by a state’s demographics as well as local, and physician practices, and hospital policies on the use of epidural/spinal anesthesia.
For additional information on the use of epidurals and risk factors associated with the procedure, see
For information on coping with labor pain, see
Childbirth Connection, Labor Pain, What You Need To Know