Epidural in labour can reduce risk of serious complications by 35%, study finds

Having an epidural during labour can reduce the risk of serious childbirth complications by 35%, according to research that suggests expanding access to the treatment may improve maternal health.

An epidural is an injection in the back to stop someone feeling pain in part of their body. Making them more widely available and providing more information to those who would benefit from one was even more important than previously thought, researchers said.

The study by the University of Glasgow and the University of Bristol involved 567,216 women who were in labour in Scottish NHS hospitals from 2007 and 2019, and went on to give birth vaginally or by an unplanned caesarean section. Of the total, 125,024 of the women had an epidural.

Researchers analysed the rate of serious complications, including heart attacks, eclampsia, and hysterectomies during childbirth. Having an epidural cut the risk of these events by 35%, the study found. The findings were published in the BMJ.

They were also more effective in women who went into labour prematurely, or who had previous medical or obstetric conditions.

Researchers said their findings suggested “expanding access to epidural analgesia for all women during labour, and particularly for those at greatest risk, could improve maternal health”.

The lead author, Prof Rachel Kearns, of the University of Glasgow, said: “This finding underscores the need to ensure access to epidurals, particularly for those who are most vulnerable – women facing higher medical risks or delivering prematurely.

“By broadening access and improving awareness, we can significantly reduce the risk of serious health outcomes and ensure safer childbirth experiences.”

Instances of severe complications during childbirth almost doubled between 2009 and 2018 in the UK, according to researchers. They said this reflects the trend of people waiting until they are older to have babies or being obese.

Prof Deborah Lawlor, of the University of Bristol, said: “That women, and their partners, have control over their treatment during pregnancy, including the use of an epidural during labour, is important.

“It is also important that women who would benefit from an epidural to prevent them becoming seriously ill are provided with easy to understand information to help them make an informed decision.”

The study was funded by NHS Research Scotland, the Medical Research Council and the British Heart Foundation.

The findings suggest that epidural analgesia may be a viable protective option for at-risk pregnancies and decision-makers should consider this new benefit to improve maternal health outcomes, experts said in a linked editorial.

They point to the importance of understanding the mechanisms behind this protective effect and recognising inequalities in uptake, with much lower rates in, for example, minority ethnic groups and socioeconomically deprived communities.

With this in mind, these findings “might serve as a catalyst for initiatives aimed at improving equitable access to epidural analgesia during labour, potentially mitigating SMM and improving maternal health outcomes across diverse socioeconomic and ethnic backgrounds,” they said.