• K A Stuart, H Krakauer, E Schone, M Lin, E Cheng, and G S Meyer.
• Department of Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
• J Perinatol. 2001 Apr 1;21(3):178-85.

ContextEpidural placement for labor in the general population of laboring women is associated with increased incidence of operative deliveries, prolongation of labor, and may be associated with an increased cesarean section rate. The risks and benefits associated with epidural placement for labor in the subpopulation of mothers at high risk for cesarean section have not been studied.ObjectiveTo determine if a population of mothers and babies at high risk for cesarean section will have improved outcomes with labor epidural placement.DesignA decision and cost analysis examining epidural placement for labor on a population of women who are at high risk for unscheduled cesarean section and may benefit from scheduled cesarean section as determined by threshold analysis was performed. Outcomes and probabilities were determined through analysis of the Department of Defense's 1996 National Quality Management Program (NQMP) Birth Product Line data set containing more than 7000 deliveries. Outcomes were defined using variables comprised of all documented conditions that occurred during the peripartum and neonatal hospitalizations. The 1997 NQMP data set was used to validate the results.SettingMilitary Treatment Facilities throughout the United States and abroad and civilian facilities in the United States providing care to military dependents.Patient PopulationActive duty and dependent pregnant women and babies.ResultsAbout 8% of mothers in this patient population were found to be at high risk for cesarean section. The decision and cost analyses showed that babies of the high risk mothers who received epidurals for labor had better clinical outcomes (p<0.05) and the procedure was cost neutral (p=0.23). The procedure did not increase the frequency of cesarean section, and there was no effect on maternal outcomes scores. These results were confirmed by the validation study.ConclusionsThere is a sizable subpopulation of women at high risk for cesarean section whose babies may have better outcomes with epidural placement with no sacrifice in maternal outcomes or costs.

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