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Epidural Ups Fever, C-section Risk

SOURCE: American Journal of Public Health 1999;89:506-510.
Copyright 1999 Reuters Limited
April 6, 1999

NEW YORK (Reuters Health) -- Women who have a fever during labor are much more likely to have a cesarean section, and epidural anesthesia tends to increase the risk of fever, according to a study by Harvard researchers.

The findings suggest that fever may be one reason why women who have an epidural are more likely to have a cesarean rather than vaginal delivery, according to a report published in the American Journal of Public Health, the journal of the American Public Health Association.

A vaginal delivery is generally considered to be preferable to a cesarean section due to a quicker recovery time and a lower risk of complications.

In the study of 1,233 low-risk women undergoing childbirth for the first time at Brigham and Women's Hospital in Boston, Massachusetts, 301 women (24%) developed a fever over 99.5 degrees Fahrenheit.

About 25% of women who developed a fever underwent a cesarean section or an assisted vaginal delivery compared with 7% to 8% of women who did not have a fever.

Nine out of 10 women with elevated temperatures had received epidural anesthesia, but not all women receiving epidural anesthesia developed fever. Of the 736 women in the study who had an epidural, 37% developed an elevated temperature, compared with about 6% of women who did not receive an epidural, report Dr. Ellice Lieberman and colleagues from Brigham and Women's and Harvard Medical School.

While a fever can be associated with an infection, the researchers found that only a few cases of elevated temperature in the study were due to infection.

Previous studies have linked epidural use to a higher rate of cesarean and assisted vaginal deliveries, but the reason for the link was unclear.

"Our data suggest that the temperature elevation that is associated with epidural use may in part explain the higher rates of cesarean and assisted vaginal delivery," the authors conclude. "Given the widespread use of epidural analgesia, we believe that it is essential that further study be conducted to determine whether treatment or prevention of fever during labor represents a practical means of lowering rates of cesarean delivery and operative vaginal delivery."