Timing of Epidural Analgesia in Labour

Over a quarter of women in Scotland are living with obesity at childbirth, and current clinical guidance recommends early epidural placement during labour for these women to reduce risks of emergency general anaesthesia. Whilst this approach aims to ensure neuraxial access under controlled conditions, the potential unintended consequences of early epidural timing—and whether these differ between women with and without obesity—remain largely unexplored at population level.

Our proposed multi-centre study will examine epidural timing effects across all of Scotland's maternity units using routinely collected electronic health records. By analysing thousands of births from diverse populations, we aim to determine whether early epidural placement — whilst achieving its intended goal of avoiding emergency general anaesthesia — may have unintended consequences on mode of birth that may differ by maternal body mass index. This research will provide crucial evidence about the full risk-benefit profile of current epidural policies, potentially informing more nuanced clinical guidelines based on comprehensive population-level data rather than single-outcome considerations.