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Epidural Associated With a Reduction in Serious Post-Birth Complications

A woman in a hospital in labor.
Credit: Jimmy Conover / Unsplash.
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In a new study, researchers have found that receiving an epidural during childbirth may reduce the risk of serious complications in the first few weeks after giving birth. The paper, published in The BMJ, may lead to improvements in maternal health.

Pregnancy complications are rising

Severe maternal morbidity (SMM) refers to 21 pregnancy conditions or procedures that could occur during pregnancy, labor or in the first few initial weeks postpartum. The complications include myocardial infarction, eclampsia and hysterectomy. Between 2009 and 2018, the incidence of SMM-affected births in the UK nearly doubled from 0.9% to 1.7% of deliveries.

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Epidural analgesia is commonly recommended to women who are considered at a high risk of SMM, including those with underlying conditions, increased body mass index or women having multiple babies. Women who give birth prematurely are also at a high risk of SMM.

 

Limited research has suggested that administering an epidural during labor may reduce the risk of SMM. A collaborative team from the University of Glasgow and the University of Bristol investigated the effect of epidural analgesia on SMM, and whether this varied in women who had a medical indication for the procedure.

Epidural analgesia may reduce the risk of complications

Data from 657,216 mothers in labor, delivering vaginally or via an unplanned cesarean section, between 2007 and 2019 in Scotland were analyzed. Their medical records were used to identify incidence of SMM from the date of delivery to 42 days postpartum.

 

Factors that may affect SMM incidence, such as maternal age, weight, ethnicity, pre-existing conditions, birth location and gestational age at birth were also considered.

 

Of the women included, 22% had an epidural and SMM occurred in 4.3 per 1000 births. Receiving an epidural during labor was associated with a 35% reduction in SMM incidence in all women in the study.

 

Women with a medical indication for an epidural had a 50% reduction of risk of SMM, compared to a 33% reduction in those without. Women who delivered prematurely saw a 47% decrease in risk with epidural use, compared to those who delivered post or post-term.

Improving awareness is essential

The researchers reported several explanations for the benefits of an epidural on SMM, including closer monitoring of women, reducing physiological stress responses to labor and avoidance of the need to anaesthesia for cesarean section.

 

Professor Rachel Kearns, lead author of the study and honorary professor in the School of Medicine, Dentistry & Nursing at the University of Glasgow, said: “Our research reveals that epidural analgesia during labor is linked to a substantial decrease in severe maternal health complications. 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.

 

Among the 77,439 women who were at a high risk of SMM, only 19,061 received an epidural. The low number highlights the importance of ensuring access and increasing awareness of this procedure to women.

 

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

 

“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,” said study author, Dr. Deborah Lawlor, professor of Epidemiology at the University of Bristol.


Reference: Kearns RJ, Kyzayeva A, Halliday LOE, Lawlor DA, Shaw M, Nelson SM. Epidural analgesia during labour and severe maternal morbidity: population based study. BMJ. 2024;385:e077190. doi: 10.1136/bmj-2023-077190


This article is a rework of a press release issued by the University of Bristol. Material has been edited for length and content.