Epidural linked to abnormal head position

Receiving epidural analgesia during labour seems to increase the risk that the baby will be delivered face up instead of the normal face-down position. This may explain the higher rate of c-sections associated with epidurals.It has been theorised that women with infants in the face-up (or occiput posterior) position have more painful labours, which leads to their request for epidural analgesia. In the current study, however, the researchers found that it was in fact more likely that the epidural was administered before a fetus moved into this position.To investigate, researchers from the Brigham and Women's Hospital in Boston examined 1,562 pregnant women during labour and delivery. Ultrasound examinations were performed when women were first admitted to the labour and delivery unit, at the time of epidural administration or 4 hours after the initial examination, and when they were close to full dilatation. Ninety-two percent of patients received epidural analgesia. Requests for epidurals were not associated with fetal position in early labour or with more painful labour.

Fetal position changes were common during labour and the initial position was not a strong predictor of position at delivery. At the initial examination, approximately 49 percent of foetuses were facing sideways, 27 percent were facing down and 24 percent were facing up. The corresponding rates at the time of delivery were 8, 80,and 12 percent.At delivery, foetuses were in the face-up position in 12.9 percent of patients given epidurals, but only 3.3 percent of those without epidurals. Epidural analgesia was not associated with the sideways-facing position.

The rate of caesarean delivery was strongly dependent on fetal position - 6.3 percent with face down, 65 percent with face up, and 74 percent with face sideways. Fetal position, however, did not influence the need for obstetrical instruments.