I know that the evidence says that there's no link between epidurals and cesareans. However, I feel like there needs to be better research done with better definitions of early and active labor, since it just seems to make sense that an epidural placed at 3cm would be more likely to lead to cesarean than an epidural placed at 7cm. What are your thoughts?
I think that whether epidurals increase likelihood of cesarean depends on the care provider. Here is an excerpt from the current draft of the epidural chapter in the manuscript for the new edition of Obstetric Myths Vs. Research Realities (to be published by University of Michigan Press) that sums up the conclusion I came to after reading the research:
The care provider’s threshold for performing cesareans will influence how he or she manages labor in general and epidurals in particular, and it is this that determines cesarean rates, not epidural use per se. (See practice variation mini-review.) Where cesarean rates are low, having an epidural may not make much difference. Where they are high, not having an epidural may make little difference. If clinicians are not committed to maximizing spontaneous vaginal births, strategies intended to minimize the epidural’s adverse impact on delivery mode will likely fail because they require belief that they will work, patience, making judgment calls that favor spontaneous birth, and quelling undue anxiety in the face of nonreassuring symptoms. Committed clinicians, on the other hand, will have these characteristics. In other words, epidurals can, but do not necessarily, increase the cesarean surgery rate.