**4.1 Epidural analgesia**

Epidural analgesia use in labor is a popular choice for pain relief among many individuals due to its effectiveness. However, the use of epidural analgesia has an impact on the progression of labor. A meta-analysis revealed that epidural anesthesia prolongs the second stage of labor by approximately 15 to 28 minutes [35], which means that patients who opt for epidural analgesia are typically given more time to complete the second stage of labor.

Additionally, studies have explored the impact of the timing of epidural administration by comparing an early versus late epidural placement. Despite some controversies, the collective findings indicate that the timing of epidural placement has minimal impact on the overall progression of labor [36]. However, a recent study of 7647 patients demonstrated an association between early epidural use (< 6 cm) and a decreased risk of a prolonged second stage of labor [37]. Based on these findings, it is reasonable to consider epidural use at any point during labor, taking into account the patient's personal values and preferences.

It is worth noting that alternative pain control options, such as intravenous and intramuscular opioids, are available but are generally recognized to be less effective than epidural analgesia, and are avoided during the second stage of labor due to concern for respiratory depression of the neonate.
