It is apparent that epidural analgesia was gaining acceptance in obstetrics at the time when the contribution of anesthesia to maternal mortality was greatest. Whether the high induction rates prevalent in the early 1970s contributed to the need for general anesthesia is difficult to assess. Thus, the increasing acceptance of epidural analgesia occurred at an opportune time for anesthetists, enabling them to gain, initially, acceptance of their practice and, later, professional credibility. Although originally regarded only as a method of relieving labor pain, epidural block, through reducing or removing the need for general anesthesia in labor, contributed to the reduction in maternal deaths following anesthesia.
Favorable experiences of epidurals soon convinced obstetricians that intervention in labor could be conveniently and relatively safely managed by offering epidural analgesia. This applied equally to another increasingly likely outcome of labor, i.e. cesarean section. Mothers' acceptance of epidurals was no less willing and may have been fostered directly or indirectly by the professionals, although encouragement to take advantage of the benefits of this service was sometimes seen by mothers as coercion.
In this way, the cascade of intervention which has been identified by some observers in current obstetric practice was facilitated by the introduction of this effective method of pain control. This phenomenon may be associated with neurological changes, causing relaxation of the pelvic floor and giving rise to malposition of the fetal head, incomplete rotation and delay, especially in the second stage of labor. Oxytocic drugs may be used to overcome delay but these are associated with fetal hypoxia, identified as fetal distress, for which interventions to expedite the birth, e.g. assistance with obstetric forceps or even cesarean section, may be deemed necessary.
-Rosemary Manders, "Epidural analgesia 1: recent history," British Journal of Midwifery, Vol. 1 No. 6 Nov./Dec. 1993
Reprinted from Midwifery Today E-News (Vol 1 Issue 9, Feb. 26, 1999)
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