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  "id": "maternal:epidural-labour-analgesia",
  "owner": "maternal",
  "kind": "intervention",
  "slug": "epidural-labour-analgesia",
  "name": "Epidural pain relief in labour",
  "aliases": [],
  "atlases": [
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  "summary_plain": "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.",
  "summary_technical": "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.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-14",
  "last_evidence_check": "2026-10-14",
  "next_review_due": null,
  "identifiers": [],
  "navigation": {
    "maternal": {
      "life-stage": [
        "childbirth"
      ],
      "care-area": [
        "labour-and-birth"
      ]
    }
  },
  "payload": {
    "subtype": "procedure",
    "mechanism": null,
    "components": null
  },
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      "id": "maternal:claim-cochrane-epidural",
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      "category": "effect",
      "statement": "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.",
      "context": {
        "id": "maternal:ctx-cochrane-epidural-women-in-labour",
        "label": "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_note": "Labour",
        "life_stage_terms": null,
        "gestational_age_min_days": null,
        "gestational_age_max_days": null,
        "gestational_age_basis": null,
        "postnatal_age_min_days": null,
        "postnatal_age_max_days": null,
        "gestational_age_status": null,
        "postnatal_age_status": null,
        "followup_description": "Follow-up differs by trial and outcome; the abstract does not give it.",
        "eligibility": {
          "inclusion": [
            "Randomised trials comparing epidural analgesia with non-epidural analgesia or no analgesia in labour; 40 trials with data"
          ],
          "exclusion": [
            "Cluster-randomised and quasi-randomised trials were not included in this update"
          ]
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      "evidence_stage": "synthesis",
      "certainty": "not_assessed",
      "certainty_method": null,
      "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.",
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      "checked_at": "2026-10-14",
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