Epidural linked to reduction in serious complications after childbirth

Medical Xpress / British Medical Journal / The BMJ ^ | May 22, 2024 | Rachel J Kearns et al

[ConservativeMind]

Having an epidural during labor is associated with a marked reduction in serious complications in the first few weeks after giving birth, finds a study.

Doctors refer to these complications as severe maternal morbidity (SMM), which can include heart attack, heart failure, sepsis, and hysterectomy.

To address this, a team set out to determine the effect of labor epidural on SMM and explore whether this was greater in women with a medical indication for epidural in labor, or those in preterm labor.

Their findings are based on Scottish National Health Service data for 567,216 mothers in labor (average age 29, 93% white) delivering vaginally or via unplanned cesarean section in Scotland between 2007 and 2019.

Medical records were used to identify any of the 21 conditions defined as SMM by the US Centers for Disease Control and Prevention or a critical care admission occurring at any point from date of delivery to 42 days after giving birth.

Of the 567,216 women, 125,024 (22%) had an epidural in labor and SMM occurred in 4.3 per 1,000 births.

Having an epidural was associated with a 35% relative risk reduction in SMM in all women in the study. Greater reductions were seen among women with a medical indication for epidural (50% risk reduction) compared to those without (33% risk reduction) and in women delivering preterm (47% risk reduction) compared to term or post-term (no evidence of reduced risk).

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.

Possible explanations for these findings include closer monitoring of both mother and baby during labor, blunting of physiological stress responses to labor, and faster escalation to obstetric interventions if needed, note the authors.

[ConservativeMind]

There may be other benefits to an epidural aside from the reduction of pain during birth.

[ConservativeMind]

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