Compared with non-epidural or no pain relief during labour, how effective is epidural analgesia?
Low-quality evidence shows epidural analgesia might be more effective in reducing pain during labour and increasing maternal satisfaction with pain relief than non-epidural methods. Epidural analgesia has no impact on the risk of caesarean section or long-term backache and does not appear to have an immediate effect on neonatal status as determined by Apgar scores or in admissions to neonatal intensive care. Women having epidural anaesthesia experience more hypotension, motor blockade, fever and urinary retention. They also have longer first and second stages of labour and are more likely to have oxytocin augmentation than women receiving opioids. Women receiving epidurals have less risk of respiratory depression requiring oxygen and are less likely to experience nausea and vomiting than women receiving opioids. Babies born to women with epidural anaesthesia are less likely to have received naloxone. There is no difference between recipients of the epidural or opioid anaesthesia for postnatal depression, headaches, itching, shivering or drowsiness. All but 6 studies compared epidural analgesia with injected opioids.
Although, overall, there appears to be an increase in assisted vaginal birth when women have epidural analgesia, a post-hoc subgroup analysis shows this effect is not seen in recent studies (after 2005), suggesting modern approaches to epidural analgesia in labour do not affect this outcome.
Epidural analgesia is a central nerve-block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain. It is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant.
Cochrane Systematic Review
Anim-Somuah M et al. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Reviews, 2018, Issue 5. Art. No.: CD000331.DOI: 10.1002/14651858. CD000331.pub4. This review contains 40 studies involving over 11,000 participants.