Epidural analgesia and instrumental delivery

In patients given epidural analgesia who had singleton vertex vaginal deliveries the normal delivery rate was 57%, compared to 80% in all this group. The increase in instrumental delivery rate could partly be accounted for by parity (primigravidae are over‐represented in the epidural group), by obstetric and medical indications for epidurals, and by the need for sitting top‐ups to relieve perineal pain. There remained a small population of patients in whom epidurals may have contributed to the need for instrumental delivery.