No problem with posting years later. The issue is certainly still current! Yes, among its other defects, epidurals increase the use of oxytocin. According to a systematic review (an analysis of all the relevant research in a structured manner) of the randomized controlled trials (RCTs) (participants are assigned by chance to one form of treatment or another) of epidurals vs. other forms of pain relief, women are 20% more likely to be given oxytocin if they have an epidural. That percentage is actually probably much greater because results are analyzed according to assignment group ("intent to treat"), not according to what treatment the individual had. The strength of an RCT is that by assigning participants to groups by chance, you get rid of some potential sources of bias. For example, women experiencing slow, difficult labors that require oxytocin to make contractions stronger are more likely to want epidurals. If you analyze according to actual treatment, you remove that strength. Analysis by "intent to treat" generally works well because in most RCTs, all but a small percentage of participants get their assigned treatment. However, in, I think, all but one of the epidural RCTs, substantial percentages of women assigned to the "no epidural" group decided they wanted an epidural. For this reason, analyzing according to "intent to treat" inflates the number of women in the "no epidural" group who had oxytocin to strengthen their labors.
-- Henci
Anim-Somuah M, Smyth R, Howell C, et al. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev 2005(4):CD000331. |