# Epidural pain relief in labour Intervention · id `maternal:epidural-labour-analgesia` · Maternal & Newborn Atlas · release `c7fb95f1d15a7d13` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Browse, life stage: Childbirth Browse, care area: Labour and birth ## In plain language An epidural is an injection of local anaesthetic close to the nerves that carry pain from the womb. It is widely used for pain relief in labour. A 2018 Cochrane review of 40 trials found low-quality evidence that it may reduce pain more than other options, mostly opioids, and may raise satisfaction with pain relief. It also has trade-offs: more low blood pressure, leg weakness, fever and difficulty passing urine, and longer labours. The review found no difference in caesarean rates. ## Technical summary Procedure. The Cochrane review (Anim-Somuah et al., 2018; PMID 29781504) included all types of epidural, with combined spinal-epidural, against non-epidural or no analgesia. Most trials compared epidural with opioids. Its authors rate the evidence as low quality for most outcomes. The review says maternal morbidity and long-term neonatal outcomes were not reported and that few trials reported serious maternal side effects. The claim holds the figures; this page holds none. The review's babies' outcomes are not summarised on this page. ## Claims, with the population each applies to ## Context: Women in labour in randomised trials of epidural analgesia against non-epidural or no analgesia (Cochrane 2018) Recipient: Maternal; Population: Women in labour who were randomised to any type of epidural analgesia, including combined spinal-epidural, or to any form of pain relief that does not involve regional blockade, or to no pain relief. Most comparisons were against opioids (34 of the trials). Use this context for outcomes measured in the women, not for the babies' outcomes that the review also reports.; Care setting: Not stated in the source; Geography: Not stated in the abstract; Life stage: Labour; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Follow-up differs by trial and outcome; the abstract does not give it. ### A 2018 Cochrane review of 40 randomised trials with over 11,000 women compared epidural analgesia in labour with non-epidural or no pain relief. Against opioids, pain scores were lower with epidural analgesia (standardised mean difference -2.64, 95% confidence interval -4.56 to -0.73; low-quality evidence) and more women rated their pain relief excellent or very good (average risk ratio 1.47, 95% CI 1.03 to 2.08; low-quality evidence), with substantial statistical heterogeneity in both; the need for additional pain relief fell (average risk ratio 0.10, 95% CI 0.04 to 0.25). More women with an epidural had an assisted vaginal birth (risk ratio 1.44, 95% CI 1.29 to 1.60; low-quality evidence), but in a post hoc analysis of trials after 2005 the difference was no longer clear (risk ratio 1.19, 95% CI 0.97 to 1.46). There was no difference in caesarean section rates (risk ratio 1.07, 95% CI 0.96 to 1.18; moderate-quality evidence). Women with an epidural had more hypotension, motor blockade, fever and urinary retention, longer first and second stages of labour, and were more likely to receive oxytocin augmentation than women given opioids. - Category: Effect - Evidence stage: Evidence synthesis - Certainty: Certainty not assessed - Applies to: Recipient: Maternal; Population: Women in labour who were randomised to any type of epidural analgesia, including combined spinal-epidural, or to any form of pain relief that does not involve regional blockade, or to no pain relief. Most comparisons were against opioids (34 of the trials). Use this context for outcomes measured in the women, not for the babies' outcomes that the review also reports.; Care setting: Not stated in the source; Geography: Not stated in the abstract; Life stage: Labour; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Follow-up differs by trial and outcome; the abstract does not give it. - Limitations: The review rates its evidence moderate to low, with the GRADE rating given outcome by outcome, so the claim certainty is left not assessed. Most trials were at high or unclear risk of detection bias. The post hoc subgroup is not a pre-specified analysis. The review also reports babies' outcomes (neonatal intensive care admission and Apgar score below seven at five minutes: no clear differences); those outcomes belong to a newborn context and are not summarised in this claim. Only the PubMed abstract was read, because the PMC copy is not in the Open Access subset. Most of the trials (34 of 40) compared epidural with opioids, so the figures do not apply to every non-epidural comparison. - Last checked: 2026-10-14 - Sources: 1. Supports: Epidural versus non-epidural or no analgesia for pain management in labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, OBJECTIVES and MAIN RESULTS, sentence 1: scope of the review. Retrieved 2026-10-14T18:18:28Z. Source state: Current. Snapshot hash: d7cb1602c83b159684d7e5f00dd34632c749ccd4d6c3e1d8dff7e1e63c7c3d6d. How it applies: PubMed abstract. 2. Supports: Epidural versus non-epidural or no analgesia for pain management in labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, MAIN RESULTS, sentences 5 to 10: pain, satisfaction, additional pain relief, assisted vaginal birth, caesarean. Retrieved 2026-10-14T18:18:28Z. Source state: Current. Snapshot hash: d7cb1602c83b159684d7e5f00dd34632c749ccd4d6c3e1d8dff7e1e63c7c3d6d. How it applies: PubMed abstract. 3. Supports: Epidural versus non-epidural or no analgesia for pain management in labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, MAIN RESULTS, sentences 13 and 14: side effects and labour length. Retrieved 2026-10-14T18:18:28Z. Source state: Current. Snapshot hash: d7cb1602c83b159684d7e5f00dd34632c749ccd4d6c3e1d8dff7e1e63c7c3d6d. How it applies: PubMed abstract. 4. Supports: Epidural versus non-epidural or no analgesia for pain management in labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, AUTHORS' CONCLUSIONS, sentence 1: low-quality evidence. Retrieved 2026-10-14T18:18:28Z. Source state: Current. Snapshot hash: d7cb1602c83b159684d7e5f00dd34632c749ccd4d6c3e1d8dff7e1e63c7c3d6d. How it applies: PubMed abstract. 5. Background: Epidural versus non-epidural or no analgesia for pain management in labour (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, MAIN RESULTS, sentence 11: babies' outcomes (not summarised). Retrieved 2026-10-14T18:18:28Z. Source state: Current. Snapshot hash: d7cb1602c83b159684d7e5f00dd34632c749ccd4d6c3e1d8dff7e1e63c7c3d6d. How it applies: PubMed abstract. ## Connected pages - Pain relief option: Labour and birth (`maternal:labour-and-birth`) - Filed under this front: Procedures and birth care (`maternal:front-procedures-and-birth-care`) ## Provenance Content hash: 5f8ab42944c2ccb4b7d2b07610fa0c005c72b1a6ab8dd1af7d62731ff4f66adb Last substantive edit: 2026-10-14 Evidence last checked: 2026-10-14