Epidural protects against maternal morbidity

Researchers report that epidural analgesia during labour is associated with a significant 35% reduction in severe maternal morbidity (SMM), which can include heart attack, heart failure, sepsis, and hysterectomy, in the first few weeks after giving birth.

The findings were published on May 22, 2024 in The BMJ.

The authors said, “Epidural analgesia during labour was associated with a 35% reduction in SMM, and showed a more pronounced effect in women with medical indications for epidural analgesia and with preterm births. Expanding access to epidural analgesia for all women during labour, and particularly for those at greatest risk, could improve maternal health.”

The primary outcome measure was SMM, defined as ≥1 of 21 conditions used by the US Centers for Disease Control and Prevention (CDC) as criteria for SMM, or a critical care admission, from delivery to 42 days post partum.

The investigators conducted a restrospective study using data taken between 1 January 2007 and 31 December 2019. All data came from NHS (UK National Health Service) clinics in Scotland.

Of a total of 567, 216 subjects, 125, 024 (22.0%) had epidural analgesia during labour, and SMM occurred in 2,412 of them (4.3 per 1000 births). 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.

The authors concluded, “These findings substantiate the current practice of recommending epidural analgesia during labour to women with known risk factors, underscore the importance of ensuring equitable access to such treatment, and highlight the importance of supporting women from diverse backgrounds to be able to make informed decisions relating to epidural analgesia during labour.”

In a linked editorial, the authors said, “Their findings showed a notable positive association, with epidural analgesia linked to a 35% reduction in SMM. This important benefit was particularly noticeable among women with a medical indication for epidural analgesia during labour and those undergoing preterm birth. The implications of these findings for obstetric anaesthetic practice and maternal health warrant careful consideration and further exploration.”