Epidurals Could Decrease Severe Birth Complications By More Than A Third, New Study Says

Plenty of people who’ve been through labor and childbirth will tell you that epidurals are a lifesaver for their ability to numb the pain of contractions and delivery. And it turns out they might just be scientifically correct in that assessment. A new study published in the British Medical Journal (BMJ) found that epidurals aren’t just great pain relief, but they might also contribute to a reduction in severe maternal morbidity (SMM), which includes a range of potentially life-threatening problems.

“Epidural anesthesia” (colloquially referred to as “an epidural”) refers to pain medication injected into the space around your spinal nerves (the epidural space) in order to reduce or completely numb a particular region of your body. In childbirth, this is particularly effective in managing the pain of contractions and delivery as it leaves patients numb from about the waist to the knees but allows them to be active and awake during the birth of their baby. Between 70 and 75% women who give birth the United States do so while using an epidural for pain relief, according to Yale Medicine.

The population analyzed in this study — 567, 216 women in labor at all National Health Service (NHS) hospitals in Scotland from January 2007 to December 2019 — utilized epidurals far less than their American counterparts, accounting for 22% of deliveries. Subjects ranged from 24 weeks gestation to 42 weeks and six days gestation, delivering vaginally or via unplanned C-section. Elective C-sections and births where data was incomplete (mode of delivery, data for analgesia during labor, etc.) were excluded from the results.

Among those who opted for epidural pain management, researchers found SMM from the day of delivery to 42 days postpartum decreased by an average of 35%. This was even more pronounced among women who delivered prematurely — a 47% reduction — and those with predefined risk factors — a 50% reduction. This is promising news, particularly as maternal complications arising from birth doubled between 2009 and 2018.

“These findings substantiate the current practice of recommending epidural analgesia during labour to women with known risk factors, underscores the importance of ensuring equitable access to such treatment, and highlights the importance of supporting women from diverse backgrounds to be able to make informed decisions relating to epidural analgesia during labour,” the authors wrote.

The researchers also noted that misinformation and misconceptions about epidural analgesia — especially when it comes to purported effects on delivery mode and neonatal well-being — might contribute to some patients eschewing epidurals. However, in the study’s cited research, there is no casual link found between epidural use and an increased risk of operative births or neonatal or long-term childhood outcomes.

“Expanding access to epidural analgesia for all women during labour,” the authors write in their conclusion, “and particularly for those at greatest risk, could improve maternal health.”

Studies referenced:

Kearns, Rachel J, et al. “Epidural Analgesia during Labour and Severe Maternal Morbidity: Population Based Study.” The BMJ, British Medical Journal Publishing Group, 22 May 2024, www.bmj.com/content/385/bmj-2023-077190.