{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:25:14Z","timestamp":1791325514206,"version":"4.3.1"},"reference-count":52,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2026,6,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine whether epidural analgesia in labour is associated with neonatal neurological morbidity, other neonatal morbidity, neonatal sepsis, low Apgar score, neonatal mortality, and childhood cerebral palsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>National population based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All NHS hospitals in Scotland, using Scottish NHS administrative linked data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>495\u2009695 women in labour with a singleton pregnancy between 24+0 and 42+6 weeks\u2019 gestation delivering vaginally or via unplanned caesarean birth between 1 January 2007 and 31 December 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was neonatal neurological morbidity defined using ICD-10 codes as one or more of hypoxic ischaemic encephalopathy, neonatal seizures, intraventricular haemorrhage, intraventricular infarction, periventricular leukomalacia, meningitis, encephalitis, kernicterus, hypotonia, birth asphyxia, or other cerebral diagnosis occurring within 28 days of birth. Secondary outcomes were other neonatal morbidity (one or more of acidosis at birth (cord artery pH &lt;7.10), traumatic birth injury, brachial plexus injury, necrotising enterocolitis, respiratory distress syndrome, respiratory failure, pneumothorax, hypoglycaemia, or hypothermia), neonatal sepsis, Apgar score &lt;4 at five minutes following birth, neonatal mortality, and cerebral palsy diagnosed at any point during childhood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 495\u2009695 women, 114\u2009897 (23.2%) had epidural analgesia in labour. Neonatal neurological morbidity occurred in 434 babies (0.9 per 1000 births, 95% confidence interval (CI) 0.8 to 1.0). No association was found between epidural analgesia in labour and neonatal neurological morbidity (adjusted relative risk 0.87, 95% CI 0.68 to 1.12), other severe neonatal morbidity (1.17, 0.90 to 1.51), neonatal sepsis (1.11, 0.90 to 1.37), Apgar score &lt;4 at five minutes (0.97, 0.87 to 1.09), neonatal mortality at 28 days (0.81, 0.62 to 1.06), or cerebral palsy in childhood (0.80, 0.60 to 1.06). Findings were consistent across subgroups including women considered to have high risk pregnancies, preterm births, and across different modes of birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Epidural analgesia during labour was not associated with clinically significant risks of harm to newborn babies or children, including risks of neonatal morbidity, death, or cerebral palsy. These findings have important policy implications, and support widening availability and equitable access to epidural analgesia as a safe component of intrapartum care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2026-343320","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:20:13Z","timestamp":1784161213000},"page":"e343320","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Epidural analgesia in labour and neonatal and childhood outcomes: national population based cohort study"],"prefix":"10.1136","volume":"394","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6156-6858","authenticated-orcid":true,"given":"Rachel J","family":"Kearns","sequence":"first","affiliation":[{"name":"Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK"},{"name":"School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aizhan","family":"Kyzayeva","sequence":"additional","affiliation":[{"name":"School of Health and Wellbeing, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarjit","family":"Singh","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah A","family":"Lawlor","sequence":"additional","affiliation":[{"name":"MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK"},{"name":"Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Nelson","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026081808150633000_394.jul15_7.e343320.1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000331.pub4"},{"key":"2026081808150633000_394.jul15_7.e343320.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2023.02.005"},{"key":"2026081808150633000_394.jul15_7.e343320.3","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.0137"},{"key":"2026081808150633000_394.jul15_7.e343320.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-077190"},{"key":"2026081808150633000_394.jul15_7.e343320.5","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.31683"},{"key":"2026081808150633000_394.jul15_7.e343320.6","doi-asserted-by":"publisher","DOI":"10.1136\/rapm-2020-102441"},{"key":"2026081808150633000_394.jul15_7.e343320.7","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14296"},{"key":"2026081808150633000_394.jul15_7.e343320.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijoa.2010.08.004"},{"key":"2026081808150633000_394.jul15_7.e343320.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010006"},{"key":"2026081808150633000_394.jul15_7.e343320.10","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31818f5eb6"},{"key":"2026081808150633000_394.jul15_7.e343320.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.06.017"},{"key":"2026081808150633000_394.jul15_7.e343320.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.09.046"},{"key":"2026081808150633000_394.jul15_7.e343320.13","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.33730"},{"key":"2026081808150633000_394.jul15_7.e343320.14","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-016-2244-8"},{"key":"2026081808150633000_394.jul15_7.e343320.15","unstructured":"NHS patient survey programme. 2019 survey of women\u2019s experiences of maternity care. https:\/\/www.cqc.org.uk\/sites\/default\/files\/20200128_mat19_statisticalrelease.pdf. 21 Aug 2025."},{"key":"2026081808150633000_394.jul15_7.e343320.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijoa.2024.104294"},{"key":"2026081808150633000_394.jul15_7.e343320.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"2026081808150633000_394.jul15_7.e343320.18","unstructured":"World Health Organization. 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