# Effects of Early and Late Labor Epidural Analgesia on Multiparous Women: A Retrospective Monocentric Study

## TL;DR

This study found that starting epidural pain relief early in labor for women who have given birth before leads to more medical interventions, while waiting until active labor reduces these interventions without harming mothers or babies.

## Contribution

The study provides new evidence on the impact of early versus late epidural analgesia initiation on labor outcomes in multiparous women.

## Key findings

- Early epidural analgesia was associated with higher rates of labor induction, augmentation, and cesarean delivery.
- Late epidural analgesia or no epidural was linked to fewer interventions and higher spontaneous vaginal delivery rates.
- Neonatal and maternal outcomes remained favorable across all groups despite differences in intervention rates.

## Abstract

Background

Epidural analgesia is a popular and effective method of pain relief in labor, but the optimal timing of its administration remains unclear for multiparous women. Some evidence suggests that initiating epidurals very early in labor may be associated with increased interventions. This study aimed to evaluate whether early labor epidural analgesia (initiated before active labor) affects delivery outcomes in multiparous women compared to late epidural or no epidural analgesia.

Methodology

We conducted a retrospective, single-center, cohort study of term multiparous women (at least 37 weeks of gestation) with singleton, cephalic pregnancies and no prior cesarean delivery, who gave birth between November 1, 2023, and April 30, 2024. Participants were divided into the following three groups based on use of neuraxial analgesia: no neuraxial analgesia (n = 421), early neuraxial analgesia (less than 3 cm of cervical dilation; n = 102), or late neuraxial analgesia (3 cm of dilation or more; n = 145). Primary outcomes were mode of delivery (vaginal versus cesarean), use of oxytocin for labor augmentation, and postpartum hemorrhage of at least 1,000 mL. Secondary outcomes included admission to a neonatal intensive care unit, Apgar scores below 7 at five minutes, and meconium-stained amniotic fluid.

Results

A total of 668 multiparous women were included. The early neuraxial analgesia group had the highest rates of labor induction (46/102, 45.10%), labor augmentation (41/102, 40.20%), and cesarean delivery (10/102, 9.80%), while the no neuraxial analgesia group had the lowest rates (98/421, 23.28%; 60/421, 14.25%; and 12/421, 2.85%, respectively). Spontaneous vaginal delivery rates were 88/102 (86.27%) for early neuraxial analgesia, 138/145 (95.17%) for late neuraxial analgesia, and 405/421 (96.20%) for no neuraxial analgesia. Postpartum hemorrhage of at least 1,000 mL occurred in 6/102 (5.88%) of the early neuraxial analgesia group, 6/145 (4.14%) of the late neuraxial analgesia group, and 8/421 (1.90%) of those without neuraxial analgesia. Neonatal intensive care unit admissions were slightly higher in the early neuraxial analgesia group (4/102, 3.92%) compared with late neuraxial analgesia (3/145, 2.07%) and no neuraxial analgesia (3/421, 0.71%) groups. Five-minute Apgar scores below 7 remained low in all groups, ranging from 0/102 (0.00%) to 1/145 (0.69%).

Conclusions

Among multiparous women, initiating epidural analgesia in early labor was associated with higher rates of labor augmentation and operative delivery, whereas late epidural analgesia or no epidural analgesia was linked to fewer interventions. Despite these differences, serious maternal complications and neonatal outcomes remained favorable across all groups. These findings suggest that delaying epidural initiation until active labor may help minimize interventions without compromising maternal or neonatal safety.