Maternal & Newborn Atlas
About
Menu

Epidural pain relief in labour

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.

  • Intervention
  • In this atlas

Overview

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.

About this intervention

Type
Procedure
Mechanism
Not reported

Claims and evidence

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.
Eligibility: 1 inclusion criterion; 1 exclusion criterion
Included
  • Randomised trials comparing epidural analgesia with non-epidural analgesia or no analgesia in labour; 40 trials with data
Excluded
  • Cluster-randomised and quasi-randomised trials were not included in this update

  • Effect Evidence synthesis Certainty not assessed

    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.

    Applies to Maternal
    • 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.
    • Not stated in the source
    • Not stated in the abstract
    • Labour
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Follow-up differs by trial and outcome; the abstract does not give it.
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (5)

    1. Supports Epidural versus non-epidural or no analgesia for pain management in labour

      Publication · The Cochrane database of systematic reviews · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2018-05-21 · DOI: 10.1002/14651858.CD000331.pub4 · PMID: 29781504 · PMCID: PMC6494646

      Locator
      Abstract, OBJECTIVES and MAIN RESULTS, sentence 1: scope of the review
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      d7cb1602c83b159684d7e5f00dd34632c749ccd4d6c3e1d8dff7e1e63c7c3d6d
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    2. Supports Epidural versus non-epidural or no analgesia for pain management in labour

      Publication · The Cochrane database of systematic reviews · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2018-05-21 · DOI: 10.1002/14651858.CD000331.pub4 · PMID: 29781504 · PMCID: PMC6494646

      Locator
      Abstract, MAIN RESULTS, sentences 5 to 10: pain, satisfaction, additional pain relief, assisted vaginal birth, caesarean
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      d7cb1602c83b159684d7e5f00dd34632c749ccd4d6c3e1d8dff7e1e63c7c3d6d
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    3. Supports Epidural versus non-epidural or no analgesia for pain management in labour

      Publication · The Cochrane database of systematic reviews · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2018-05-21 · DOI: 10.1002/14651858.CD000331.pub4 · PMID: 29781504 · PMCID: PMC6494646

      Locator
      Abstract, MAIN RESULTS, sentences 13 and 14: side effects and labour length
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      d7cb1602c83b159684d7e5f00dd34632c749ccd4d6c3e1d8dff7e1e63c7c3d6d
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    4. Supports Epidural versus non-epidural or no analgesia for pain management in labour

      Publication · The Cochrane database of systematic reviews · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2018-05-21 · DOI: 10.1002/14651858.CD000331.pub4 · PMID: 29781504 · PMCID: PMC6494646

      Locator
      Abstract, AUTHORS' CONCLUSIONS, sentence 1: low-quality evidence
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      d7cb1602c83b159684d7e5f00dd34632c749ccd4d6c3e1d8dff7e1e63c7c3d6d
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    5. Background Epidural versus non-epidural or no analgesia for pain management in labour

      Publication · The Cochrane database of systematic reviews · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2018-05-21 · DOI: 10.1002/14651858.CD000331.pub4 · PMID: 29781504 · PMCID: PMC6494646

      Locator
      Abstract, MAIN RESULTS, sentence 11: babies' outcomes (not summarised)
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      d7cb1602c83b159684d7e5f00dd34632c749ccd4d6c3e1d8dff7e1e63c7c3d6d
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Record details

Record id
maternal:epidural-labour-analgesia
Content hash
5f8ab42944c2ccb4b7d2b07610fa0c005c72b1a6ab8dd1af7d62731ff4f66adb