Epidurals in labour: Is the birth shorter if the epidural is stopped late in labour?

Some hospitals recommend stopping epidurals late in labour to try and end the birth with less medical help. However there is no evidence that this brings the hoped-for advantages.

Epidurals are a popular choice for pain relief in childbirth. You can read more about epidurals in our Fact Sheet. Epidurals relieve pain effectively, but one of the disadvantages is that some women lose the urge to push. This can lengthen the second or pushing stage of labour, which can increase the risk of needing a so-called 'instrumental delivery' or assisted birth. That means a birth where forceps or a vacuum extractor is used to help with the baby's birth. Some hospitals let the epidural end late in the labour, in the hope that this might mean the woman can give birth without extra medical help.

Researchers from the Cochrane Collaboration studied the impact of ending an epidural earlier. They looked at trials that compared having an epidural to the end, or stopping it early. There were not a lot of trials: altogether, only around 460 women were studied.

These small numbers meant that the Cochrane authors remained cautious in their conclusions. They concluded that the trials do not provide evidence that stopping an epidural early shortens the birth. There was no important difference in the rate of assisted birth or caesarean section when the epidural was stopped early.

One definite difference was in the amount of pain. After the epidural ended more women found that their pain relief was inadequate. They were not asked, though, how they felt about the birth or their care. So we do not know which practice women would prefer.

© IQWiG (Institute for Quality and Efficiency in Health Care)