Objective 

To determine if epidural analgesia is associated with differences in rates of severe perineal trauma during vaginal deliveries.

Methods 

We studied 1942 consecutive, low-risk, term, vaginal deliveries in nulliparas, including spontaneous and induced labors, at a single institution from December 1994 to August 1995.

The rate of third-and fourth-degree lacerations was compared for women who had and did not have epidural analgesia for labor-pain relief.

Statistical significance was determined using X2.

Logistic regression analyses were used to evaluate associations while controlling for possible confounding variables.

Results 

Overall rates of third-and fourth-degree lacerations were 10.8% (n=210) and 3.4% (n=63), respectively.

Epidural analgesia was given to 1376 (70.9%) women.

Among women who had epidurals, 16.1% (221 of 1376) had severe perineal lacerations compared with 9.7% (n=55) of the 566 women who did not have epidurals (P<. 001 ; odds ratio [OR] 1.8,95% confidence interval [CI] 1.3,2.4).

When controlling for birth weight, use of oxytocin, and maternal age in logistic regression analysis, epidural remained a significant predictor of severe perineal injury (OR 1.4,95% CI 1.0,2.0). (...)