Receiving an epidural during labor is not associated with a clinically significant increased risk of harm to the newborn, such as brain injury, severe breathing problems, sepsis and death, or cerebral palsy from childhood onwards.
The researchers said these findings “support the expansion of availability and equitable access to epidural analgesia as a safe component of intrapartum care.”
Epidural analgesia during labor provides effective pain relief and may help reduce maternal complications after delivery, but evidence of its effects on neonatal and child health is limited.
To address this, researchers analyzed data from 495,695 births over 13 years (2007 to 2019) in Scotland to determine whether epidural analgesia during labor was associated with severe neurological symptoms occurring within the first 28 days of birth.
Only women who delivered one baby vaginally or by unplanned caesarean section between 24 and 42 weeks of gestation were included in the analysis.
Additional precautions included other severe neonatal illnesses, sepsis, low Apgar score at five minutes after birth, death within 28 days of birth, and being diagnosed with cerebral palsy at some point in childhood.
Factors such as maternal age, ethnicity, weight, presence of preeclampsia or diabetes, smoking history, place of birth, and gestational age at birth were also taken into account.
Of the roughly 500,000 women who participated in the study, about one in four received an epidural during childbirth. Overall, severe neurological symptoms were rare, affecting fewer than 1 in 1,000 infants. These symptoms occurred at expected rates and were less common among babies whose mothers received an epidural than among those whose mothers did not.
No association was found between intrapartum epidural analgesia and severe neurological conditions, other severe neonatal illnesses, sepsis, lower Apgar scores at 5 minutes, death at 28 days, or childhood cerebral palsy.
As this is an observational study, firm conclusions about cause and effect cannot be drawn, and the authors acknowledge that as the study was limited to women giving birth in Scotland, which has a majority white population, the findings may not apply to more ethnically diverse populations or other health care settings.
However, this was a large study with long-term follow-up of neonatal and childhood outcomes, and the results were consistent after additional analysis across different groups, including women considered to have high-risk pregnancies or premature birth, supporting the reliability of the results.
The authors therefore concluded that “these results should reassure parents and clinicians that epidural analgesics used during childbirth are safe for babies and support informed, evidence-based decision-making about analgesic options during childbirth.”
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Reference magazines:
RJ Kearns, others. (2026). Epidural analgesia in labor and neonatal and childhood outcomes: a national population-based cohort study. B.M.J. DOI: 10.1136/bmj-2026-343320. https://www.bmj.com/content/394/bmj-2026-343320
