Epidural Analgesia and Its Impact on the Duration of the Second Stage of Labor, Vacuum Extraction Delivery, and Neonatal Apgar Scores: A Retrospective Cohort Study

Background and Objectives: Epidural analgesia is widely used for intrapartum pain relief; nonetheless, its associations with labor progression and neonatal outcomes remain incompletely characterized in diverse obstetric populations. This retrospective cohort study aimed to investigate the association between labor epidural analgesia and obstetric outcomes, with a focus on the duration of the second stage of labor and the vacuum extraction delivery (VED) rate. Materials and Methods: Maternal and neonatal outcomes were compared between 173 women without epidural analgesia and 386 women with epidural analgesia at a single tertiary center. Independent predictors of VED, duration of the second stage of labor, and 1-min Apgar score ≤ 6 were identified by conducting multivariate logistic and linear regression analyses. Results: After adjustment for maternal age, body mass index, gestational age, parity, labor induction, and comorbidities, epidural analgesia was identified as the strongest independent predictor across all three outcomes. Notably, epidural analgesia was associated with nearly 6.7-fold higher odds of VED (adjusted odds ratio [aOR]: 6.74, 95% confidence interval [CI]: 3.55–12.82), approximately 49 additional min for second-stage labor (β = 48.63, 95% CI: 32.74–64.52), and approximately 5-fold higher odds of low 1-min Apgar score (aOR: 5.14, 95% CI: 1.11–23.87). Higher parity and labor induction were independently associated with a shorter duration of the second stage of labor and with lower odds of instrumental delivery. These associations remained robust after propensity score matching for parity and other baseline covariates, as well as in parity-stratified subgroup analysis (all p < 0.05). Conclusions: These findings highlight the multifaceted obstetric impact of epidural analgesia and underscore the importance of individualized intrapartum monitoring and informed patient counseling.