Epidural: Associated with reduction in severe maternal health complications

Receiving an epidural during labour is associated with a significant reduction in severe maternal morbidity (serious health problems during childbirth or the six weeks following birth), according to new research that looked at data from more than half a million mothers in the UK.

The findings suggest that improving access to epidurals during labour, alongside better information on the procedure for mothers, may help to decrease the risk of serious adverse health outcomes occurring from the time of birth to six weeks postnatally in the UK.

The latest study, which is published in the BMJ and led by researchers at the University of Glasgow in collaboration with the University of Bristol, looked at health data from 567,216 mothers in labour between 2007 and 2019 (delivering vaginally or via unplanned caesarean section) in Scotland, in order to find out whether having an epidural was associated with any reduction in serious maternal health outcomes.

Overall, the study found that having an epidural was associated with a 35% reduction in severe maternal morbidity. Additionally, researchers found there was an even greater risk reduction associated with having an epidural for women who were delivering a baby pre-term and for those who already had conditions which put them at higher risk of poor health outcomes, and for whom an epidural would already be considered advisable.

The incidence of severe maternal morbidity – which includes conditions such as severe cardiovascular complications and procedures such as a hysterectomy during birth – almost doubled in the UK from 0.9% of deliveries in 2009 to 1.7% in 2018. This increase is thought to be linked to wider population trends of having children older, rising rates of obesity, as well as prior caesarean deliveries.

The benefits of receiving an epidural include optimal pain relief as well as medical benefits, in particular, aiding the quick delivery of further anaesthetic in an emergency situation. However, the final decision to accept epidural pain relief remains with the mother, who can decide not to take it even when advised.

According to the study data, many of the women who were most at risk of serious health complications did not receive an epidural during labour. The research found that, overall, an epidural was administered to 125,024 (22.0%) women included in the study, with 442,192 (78.0%) not receiving an epidural. Notably, among the 77,439 women in the study who were at higher risk of severe maternal morbidity, only 19,061 (24.6%) received an epidural.

Previous studies, including by the authors of this study, have found that while women from minority ethnic groups and areas of socioeconomic deprivation are at higher risk of maternal morbidity and maternal death, they are also less likely to have an epidural. A recent study from the same team of researchers found that those from the most deprived areas were 16% less likely to receive epidural pain relief during labour.

Researchers believe this latest research provides robust evidence on the wider benefits of receiving an epidural, particularly for those at greater risk of severe complications, and that this information should be used to help better inform clinicians and mothers.

Professor Rachel Kearns, lead author of the study from the University of Glasgow, said: “Our research reveals that epidural analgesia during labour 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.

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

Professor Deborah Lawlor from 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, ‘Epidural analgesia in labour and severe maternal morbidity: a population-based study’ is published in the BMJ. The work was funded by NHS Research Scotland, the Medical Research Council and the British Heart Foundation.