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Epidural administration
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==Society and culture== Some people continue to be concerned that women who are administered epidural analgesia during labor are more likely to require a cesarean delivery, based on older observational studies.<ref name="Seyb1999">{{cite journal|vauthors=Seyb ST, Berka RJ, Socol ML, Dooley SL|year=1999|title=Risk of cesarean delivery with elective induction of labour at term in nulliparous women|journal=Obstet Gynecol|volume=94|issue=4|pages=600β607|doi=10.1016/S0029-7844(99)00377-4|pmid=10511367}}</ref> However, evidence has shown that the use of epidural analgesia during labor does not have any statistically significant effect on the necessity to perform a cesarean delivery. A 2018 Cochrane review found no increase in the rate of Caesarean delivery when epidural analgesia was employed.<ref name="Anim-Somuah2018" /> However, epidural analgesia does lengthen the second stage of labor by 15 to 30 minutes, which may increase the risk a delivery must be assisted by instruments.<ref name="Liu2004">{{cite journal|vauthors=Liu EH, Sia AT|date=June 2004|title=Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review |journal=BMJ |volume=328 |issue=7453 |page=1410 |doi=10.1136/bmj.38097.590810.7C |pmc=421779 |pmid=15169744}}</ref><ref name="Halpern2004">{{cite journal|vauthors=Halpern SH, Muir H, Breen TW, Campbell DC, Barrett J, Liston R, Blanchard JW|date=November 2004|title=A multicenter randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labor|journal= Anesthesia & Analgesia|volume=99|issue=5|pages=1532β8; table of contents|doi=10.1213/01.ANE.0000136850.08972.07|pmid=15502060|s2cid=42337310|doi-access=free}}</ref> In the United States in 1998, it was reported that over half of childbirths involved the use of epidural analgesia,<ref>{{cite journal |last1=Vincent RD |first1=Jr |last2=Chestnut |first2=DH |title=Epidural analgesia during labor. |journal=American Family Physician |date=15 November 1998 |volume=58 |issue=8 |pages=1785β92 |pmid=9835854}}</ref> and by 2008 this had increased to 61% of births.<ref name=CDC2008>{{cite report |vauthors=Osterman M, Martin JA |date= 6 April 2011 |title= Epidural and Spinal Anesthesia Use During Labor: 27-state Reporting Area, 2008 |url=https://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf |publisher=[[Centers for Disease Control and Prevention]] |access-date=1 November 2020}}</ref> In the United Kingdom, epidurals have been offered through the [[National Health Service]] for all women during childbirth since 1980. By 1998, epidural analgesia was used in the UK for almost 25% of childbirths.<ref>{{cite journal |last1=Burnstein |first1=R. |last2=Buckland |first2=R. |last3=Pickett |first3=J. A. |title=A survey of epidural analgesia for labour in the United Kingdom: Epidural analgesia for labour in the UK |journal=Anaesthesia |date=July 1999 |volume=54 |issue=7 |pages=634β640 |doi=10.1046/j.1365-2044.1999.00894.x|pmid=10417453 |s2cid=39476161 |doi-access=free }}</ref> In Japan, most childbirths take place in primary or secondary hospitals in which epidural analgesia is not offered.<ref>{{cite journal |last1=Suzuki |first1=R |last2=Horiuchi |first2=S |last3=Ohtsu |first3=H |title=Evaluation of the labor curve in nulliparous Japanese women. |journal=American Journal of Obstetrics and Gynecology |date=September 2010 |volume=203 |issue=3 |pages=226.e1β6 |doi=10.1016/j.ajog.2010.04.014 |pmid=20494329}}</ref> In some developed countries, over 70% of childbirths involve epidural analgesia.<ref>{{cite journal |last1=Bucklin |first1=BA |last2=Hawkins |first2=JL |last3=Anderson |first3=JR |last4=Ullrich |first4=FA | title=Obstetric anesthesia workforce survey: twenty-year update. |journal=Anesthesiology |date=September 2005 |volume=103 |issue=3 |pages=645β53 |doi=10.1097/00000542-200509000-00030 |pmid=16129992|doi-access=free }}</ref> Other studies have shown that minority women and immigrants are less likely to receive epidural analgesia during childbirth.<ref>{{cite journal |last1=Glance |first1=LG |last2=Wissler |first2=R |last3=Glantz |first3=C |last4=Osler |first4=TM |last5=Mukamel |first5=DB |last6=Dick |first6=AW |title=Racial differences in the use of epidural analgesia for labor. |journal=Anesthesiology |date=January 2007 |volume=106 |issue=1 |pages=19β25 |doi=10.1097/00000542-200701000-00008 |pmid=17197841|s2cid=22643036 |doi-access=free }}</ref> Even in countries with universal healthcare coverage such as Canada, socioeconomic factors such as race, financial stability, and education influence the rate at which women receive epidural analgesia.<ref>{{cite journal |last1=Liu |first1=N |last2=Wen |first2=SW |last3=Manual |first3=DG |last4=Katherine |first4=W |last5=Bottomley |first5=J |last6=Walker |first6=MC |title=Social disparity and the use of intrapartum epidural analgesia in a publicly funded health care system. |journal=American Journal of Obstetrics and Gynecology |date=March 2010 |volume=202 |issue=3 |pages=273.e1β8 |doi=10.1016/j.ajog.2009.10.871 |pmid=20045506}}</ref> One survey in 2014 found that over half of pregnant women in a Nigerian antenatal clinic (79.5%) did not know what epidural analgesia was or what it was used for, while 76.5% of them would utilize epidural analgesia if offered after it was explained to them.<ref>{{cite journal |last1=Okojie |first1=NQ |last2=Isah |first2=EC |title=Perception of Epidural Analgesia for Labour Among Pregnant Women in a Nigerian Tertiary Hospital Setting |journal=Journal of the West African College of Surgeons |date=October 2014 |volume=4 |issue=4 |pages=142β62 |pmid=27182515|pmc=4866730 }}</ref>
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