flexible catheter for continuous caudal anesthesia in a woman in labor in 1942. In 1947, Manuel Curbelo described placement of a lumbar epidural catheter, and in 1979, Behar reported the first use of an epidural to administer narcotics. Society and culture Some people continue to be concerned that women who are administered epidural analgesia during labor are more likely to require a cesarean delivery, based on older observational studies. However, evidence has shown that the use of epidural analgesia during labor does not have any statistically significant effect on the necessity to perform a cesarean delivery. A 2018 Cochrane review found no increase in the rate of Caesarean delivery when epidural analgesia was employed. However, epidural analgesia does lengthen the second stage of labor by 15 to 30 minutes, which may increase the risk a delivery must be assisted by instruments. In the United States in 1998, it was reported that over half of childbirths involved the use of epidural analgesia, and by 2008 this had increased to 61% of births. In the United Kingdom, epidurals have been offered through the National Health Service for all women during childbirth since 1980. By 1998, epidural analgesia was used in the UK for almost 25% of childbirths. In Japan, most childbirths take place in primary or secondary hospitals in which epidural analgesia is not offered. In some developed countries, over 70% of childbirths involve epidural analgesia. Other studies have shown that minority women and immigrants are less likely to receive epidural analgesia during childbirth. Even in countries with universal healthcare coverage such as Canada, socioeconomic factors such as race, financial stability, and education influence the rate at which women receive epidural analgesia. One survey in 2014 found that over half of pregnant women in a Nigerian antenatal clinic (79.5%) did not know what epidural analgesia was or what it was used for, while 76.5% of them would utilize epidural analgesia if offered after it was explained to them. References Further reading Boqing Chen and Patrick M. Foye, UMDNJ: New Jersey Medical School, Epidural Steroid Injections: Non-surgical Treatment of Spine Pain, eMedicine: Physical Medicine and Rehabilitation (PM&R), August 2005. Also available online. External links MedlinePlus Encyclopedia Childbirth Regional anesthesia Obstetrical procedures Dosage forms Spanish inventions