News | Maternal Health: Potential Benefits of Epidural Analgesia
A study published in The BMJ on May 22 found that epidural analgesia during labor was associated with a significantly lower risk of severe maternal morbidity (SMM) in the weeks after delivery.
Doctors use SMM to describe complications including heart attack, heart failure, sepsis, and hysterectomy.
Epidural analgesia is recommended for women with known SMM risk factors, such as obesity, certain underlying conditions, or multiple pregnancy. These women are considered to have a medical indication for an epidural during labor. Women who deliver prematurely also have a higher risk of SMM.
Some studies suggest that epidural analgesia during labor may reduce SMM risk, but evidence has been limited.
Researchers from the University of Glasgow and the University of Bristol therefore examined the effect of labor epidural analgesia on SMM and whether the effect was greater among women with a medical indication or preterm delivery.
The study used National Health Service data from Scotland and included 567,216 women who delivered there from 2007 to 2019 by vaginal birth or unplanned cesarean section. Their average age was 29, and 93% were White.
Medical records were used to identify 21 SMM conditions defined by the U.S. Centers for Disease Control and Prevention or admission to critical care within 42 days after delivery.
The analysis accounted for maternal age, ethnicity, weight, smoking history, medical history, place of birth, and gestational age at delivery.
Of 567,216 women, 125,024 (22%) received an epidural during labor. The SMM rate was 4.3 per 1,000 births.
Epidural use was associated with a 35% lower relative risk of SMM overall. Risk was 50% lower among women with a medical indication and 33% lower among those without one. It was 47% lower among women who delivered prematurely, while no reduction was found among those delivering at or after term.
Only 19,061 of 77,439 high-risk women (24.6%) received an epidural.
Possible explanations include closer monitoring of mother and baby during labor, a reduced physiological stress response, and faster obstetric intervention.
Epidural use was relatively low, especially among women with a medical indication. This may reflect limited awareness of potential benefits, because the decision to have an epidural belongs to the patient.
This observational study cannot establish causation, and the authors acknowledge limitations that may have affected the results. Most participants were White women delivering in Scotland, which may limit generalizability to other ethnic groups or healthcare settings.
Nevertheless, this was a large, well-designed study reflecting contemporary obstetric and anesthesia practice. Similar results in additional analyses supported the robustness of the findings.
The authors concluded that the findings support current recommendations for epidural analgesia during labor among women with known risk factors, underscore the importance of equitable access, and highlight the need to support informed decisions about labor analgesia among women from different backgrounds.
In a related editorial, researchers said epidural analgesia may be a viable protective option in high-risk pregnancies and that policymakers should consider this potential benefit when seeking to improve maternal health outcomes.
They noted the importance of understanding the mechanism behind the protective association and addressing unequal uptake, including lower rates among ethnic minority groups and socioeconomically disadvantaged communities.
They concluded that the findings could encourage initiatives to improve equitable access to epidural analgesia during labor, potentially reducing SMM and improving maternal outcomes across socioeconomic and ethnic groups.
News | Maternal Health: Potential Benefits of Epidural Analgesia
News | Maternal Health: Potential Benefits of Epidural Analgesia
A study published in The BMJ on May 22 found that epidural analgesia during labor was associated with a significantly lower risk of severe maternal morbidity (SMM) in the weeks after delivery.
Doctors use SMM to describe complications including heart attack, heart failure, sepsis, and hysterectomy.
Epidural analgesia is recommended for women with known SMM risk factors, such as obesity, certain underlying conditions, or multiple pregnancy. These women are considered to have a medical indication for an epidural during labor. Women who deliver prematurely also have a higher risk of SMM.
Some studies suggest that epidural analgesia during labor may reduce SMM risk, but evidence has been limited.
Researchers from the University of Glasgow and the University of Bristol therefore examined the effect of labor epidural analgesia on SMM and whether the effect was greater among women with a medical indication or preterm delivery.
The study used National Health Service data from Scotland and included 567,216 women who delivered there from 2007 to 2019 by vaginal birth or unplanned cesarean section. Their average age was 29, and 93% were White.
Medical records were used to identify 21 SMM conditions defined by the U.S. Centers for Disease Control and Prevention or admission to critical care within 42 days after delivery.
The analysis accounted for maternal age, ethnicity, weight, smoking history, medical history, place of birth, and gestational age at delivery.
Of 567,216 women, 125,024 (22%) received an epidural during labor. The SMM rate was 4.3 per 1,000 births.
Epidural use was associated with a 35% lower relative risk of SMM overall. Risk was 50% lower among women with a medical indication and 33% lower among those without one. It was 47% lower among women who delivered prematurely, while no reduction was found among those delivering at or after term.
Only 19,061 of 77,439 high-risk women (24.6%) received an epidural.
Possible explanations include closer monitoring of mother and baby during labor, a reduced physiological stress response, and faster obstetric intervention.
Epidural use was relatively low, especially among women with a medical indication. This may reflect limited awareness of potential benefits, because the decision to have an epidural belongs to the patient.
This observational study cannot establish causation, and the authors acknowledge limitations that may have affected the results. Most participants were White women delivering in Scotland, which may limit generalizability to other ethnic groups or healthcare settings.
Nevertheless, this was a large, well-designed study reflecting contemporary obstetric and anesthesia practice. Similar results in additional analyses supported the robustness of the findings.
The authors concluded that the findings support current recommendations for epidural analgesia during labor among women with known risk factors, underscore the importance of equitable access, and highlight the need to support informed decisions about labor analgesia among women from different backgrounds.
In a related editorial, researchers said epidural analgesia may be a viable protective option in high-risk pregnancies and that policymakers should consider this potential benefit when seeking to improve maternal health outcomes.
They noted the importance of understanding the mechanism behind the protective association and addressing unequal uptake, including lower rates among ethnic minority groups and socioeconomically disadvantaged communities.
They concluded that the findings could encourage initiatives to improve equitable access to epidural analgesia during labor, potentially reducing SMM and improving maternal outcomes across socioeconomic and ethnic groups.
Source:
Collected online