Epidural analgesia in labor is generally accepted as safe and effective and therefore has become increasingly popular. However, little is known regarding the effect of
epidural analgesia on the incidence of
cesarean section for
dystocia in nulliparous women. During the first 6 months of 1987 we studied 711 consecutive nulliparous women at term, with cephalic fetal presentations and spontaneous onset of labor. Comparison of 447 patients who received
epidural analgesia in labor with 264 patients who received either
narcotics or no
analgesia was performed. The incidence of
cesarean section for
dystocia was significantly greater (p less than 0.005) in the epidural group (10.3%) than in the nonepidural group (3.8%). There remained a significantly increased incidence (p less than 0.005) of
cesarean section for
dystocia in the epidural group after selection bias was corrected and the following confounding variables were controlled by multivariate analysis: maternal age, race, gestational age, cervical dilatation on admission, use of
oxytocin, duration of
oxytocin use, maximum infusion rate of
oxytocin, duration of labor, presence of meconium, and
birth weight. The incidence of
cesarean section for
fetal distress was similar (p greater than 0.20) in both groups. There were no clinically significant differences in frequency of low Apgar scores at 5 minutes or cord arterial and venous blood gas parameters between the two groups. This study suggests that
epidural analgesia in labor may increase the incidence of
cesarean section for
dystocia in nulliparous women.