Epidural During Birth Does Not Increase Risk to Baby
A review of almost half a million records found no increased risk to babies following birth with epidural analgesia.
Epidural analgesia is one of the most effective forms of pain relief during birth. While its effects on the birthing person are well established, the implications for the baby are more of a mystery, raising questions about whether the medication itself or the associated changes in labor progression, such as a prolonged second stage, can cause harm.
Researchers from the University of Glasgow and the University of Bristol conducted a large-scale, observational study to evaluate the validity of this concern. The findings, published in The BMJ, provide evidence that there is no difference in neonatal risk between births with and without epidural analgesia.
The evolution of pain relief in childbirth
In the early 1900s, analgesia during labor was frowned upon; pain was deemed a necessary part of childbirth.
Dr. John Bonica, a military doctor and “father of pain management,” endeavored to change this after watching his wife face a life-threatening situation following complications of open-drop ether anesthesia, a dangerous method—with uncontrolled dosing and high flammability risk—that is no longer used in modern clinical practice.
During her second birth c.1944, Bonica’s wife, Emma, was one of the first women to receive a continuous epidural, which is common practice in modern obstetrics.
Continuous epidural
During a continuous epidural, pain medications are continuously delivered to the patient via a catheter (tube) placed into the epidural space of the spine. The needle is strategically placed to block nerve transmission, preventing signals from traveling to the brain, providing regional pain relief for patients during labor. Epidurals are primarily used for vaginal births but may also be used in cesarean sections (C-sections).
From the 1960s onward, pain relief in childbirth was increasingly accepted and implemented. Clinicians recognized that poorly controlled maternal pain could negatively affect both the person giving birth and the newborn by triggering a stress response, increasing adrenaline and cortisol release, while reducing oxytocin activity; a key driver of contractions.
Today, analgesia uptake during labor varies geographically. In the United States, approximately three out of four mothers choose to have an epidural or spinal block.
While research has identified that adequate pain relief reduces the risk of severe maternal morbidity, the evidence around how epidurals influence neonatal outcomes specifically remains incomplete.
Evaluating the impact of epidurals on neonatal outcomes
To evaluate whether epidurals increase the risk of harm to newborns, researchers analyzed data from close to half a million births (N=495,695) across NHS hospital trusts in Scotland from 2007–2013.
Women with a singleton pregnancy between 24 and 42 weeks of gestation who had either a vaginal delivery or an unplanned C-section were included in the analysis. Planned C-section births were excluded, as a spinal block is more commonly used in these cases.
While previous reviews have explored outcomes such as neonatal unit admission and Apgar scores (neonatal vital signs) following epidural versus non-epidural births, none have covered outcomes as comprehensively as this most recent study.
Neonatal outcomes assessed
- Primary: Neurological morbidity within 28 days of birth. Defined as one or more of the following: hypoxic-ischemic encephalopathy, neonatal seizures, intraventricular hemorrhage, intraventricular infarction, periventricular leukomalacia, meningitis, encephalitis, kernicterus, hypotonia, birth asphyxia, or other cerebral diagnosis.
- Secondary: Neonatal morbidity at various time points post-birth. This included one or more of the following: acidosis at birth, traumatic birth injury, brachial plexus injury, necrotizing enterocolitis, respiratory distress syndrome, respiratory failure, pneumothorax, hypoglycemia, hypothermia, neonatal sepsis, and neonatal mortality. This also included an Apgar score of less than four at five minutes post-birth and cerebral palsy diagnosed at any point during childhood.
Almost one in four women included in the analysis received an epidural.
The study found no difference in neonatal outcomes between those born with and without epidural analgesia.
This finding remained after adjusting for maternal risk factors and gestational age, and was consistent across modes of delivery: vaginal, instrumental, and C-section.
In one subgroup, among women who had a preterm birth, epidural analgesia was linked to a reduced risk of an Apgar score less than four. A score below this threshold is critically low and would indicate that the neonate is experiencing severe distress and requires medical support.
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Therefore, across all groups, there was no increased risk of adverse neonatal outcomes, including cerebral illness, traumatic birth injury, sepsis, or death, for neonates whose mothers had opted for an epidural.
More to be done in maternity care
The findings support the results of previous reviews on neonatal outcomes following epidural analgesia during birth and begin to address remaining gaps.
"Our study addresses key gaps in a wider body of literature supporting that epidural analgesia in labor is safe for neonates," said the authors.
Despite being a large and comprehensive review of NHS Scotland records, the validity of these findings depends on the accuracy of the data within medical records and is limited to the individuals represented in the study population.
Although the authors noted that 90% of the data met quality assurance standards, maternal ethnicity was missing in over one-third of records, and more than half of eligible patients had missing confounder data, which was filled via imputation. Additionally, among those with maternal ethnicity information available, ~92% were white.
Future studies would benefit from larger geographic footprints and more diverse populations to ensure that the findings are consistent, especially across minority ethnic groups who face poorer pregnancy outcomes.
Despite this, the study represents an important step towards more informed and choice-centered maternity care. “These results should reassure parents and clinicians that epidural analgesia use in labor is safe for babies and support informed, evidence-based decision making about analgesic options in labor,” the authors concluded.
Reference: Kearns RJ, Kyzayeva A, Singh S, et al. Epidural analgesia in labour and neonatal and childhood outcomes: national population-based cohort study. The BMJ. 2026. doi: 10.1136/bmj-2026-343320
This article is a rework of a press release issued by The BMJ. Material has been edited for length and content.
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