Is an Epidural in Labour Safe for My Baby? What Two Large Studies Found, from Birth to Age Eleven

Nearly half a million Scottish births (Kearns et al., BMJ 2026) and almost 2,000 Swedish children followed into school age (Asif et al., Anaesthesia 2026)

Many parents worry that an epidural in labour might harm their baby. Two large 2026 studies, of nearly half a million births in Scotland and almost 2,000 Swedish children followed to age eleven, found no evidence that epidurals increase the risk of serious newborn illness, death, cerebral palsy or behaviour problems. Early differences were explained by differences between the mothers and their labours.

Why parents ask this question

An epidural is a thin tube placed in the lower back during labour. Pain-relieving medicine flows through it to numb the nerves that carry labour pain. It relieves labour pain better than other methods [1], and many women find it makes a long or difficult birth much more bearable. Because the medicine is given while the baby is still inside the womb, it is natural to wonder whether it could affect the baby. Some women decline an epidural because of fears and confusing information they have heard [2], and some say they are worried about effects on their baby [3]. These questions also come up later, for example when a newborn needs care in a neonatal unit or when a child is diagnosed with a developmental condition. This article looks at what two new studies, one from Scotland [3] and one from Sweden [4], can tell families.

What we knew before, and why it was not enough

Researchers have compared epidurals with other pain relief for decades. The best-known summary, a Cochrane review, combined 40 studies involving more than 11,000 women in which women were randomly assigned to an epidural or another option [1]. Epidurals relieved pain better. They also made some side effects, such as low blood pressure, a raised temperature and a longer labour, more common for mothers. For babies, the review found no clear difference in admissions to the neonatal unit or in Apgar scores, the quick check of a baby's breathing, heart rate and colour shortly after birth. The trials did not follow babies beyond the newborn period, and they did not look at rare but serious problems such as newborn brain injury [3].

Over the following years, two worries grew. The first was about fever. Women with an epidural are more likely to develop a raised temperature in labour [5]. This happens in about 15% to 25% of women with an epidural, is thought to come from inflammation without infection and possibly from changes in how the body controls temperature, and is hard to tell apart from an infection of the womb [6]. Because fever in labour from any cause has been linked to brain injury in newborns, doctors wanted to know whether epidurals might be indirectly harmful [5]. The second worry was about autism. In 2020 a study from Southern California reported that children whose mothers had an epidural were diagnosed with autism somewhat more often [7]. Later studies from Canada, Denmark and the United States found much smaller differences or none at all [8][9][10]. A Nordic study of about 4.5 million children then compared brothers and sisters within the same families. In those comparisons the difference disappeared, which suggests that family factors, rather than the epidural, explained the earlier findings [11]. Earlier Scottish research had been reassuring about babies' health and development at two years [12], and a large Californian study found no link between epidurals and a type of newborn brain injury caused by a shortage of oxygen [13]. Before the Scottish study, only two studies, both from the United States, had looked at serious newborn brain injury or cerebral palsy. One left out babies born before 35 weeks, and neither took account of the mother's own health risks [3].

How the two new studies worked

The Scottish team used the health records of births in NHS hospitals in Scotland from 2007 to 2019 [3]. They focused on 495,695 births in hospital maternity units, where every woman could have had an epidural if she wanted one. In 114,897 of these births, almost one in four, the mother had an epidural. The researchers compared babies whose mothers did and did not have an epidural. They looked at serious brain-related problems in the first four weeks of life, such as seizures, bleeding in the brain or brain injury from lack of oxygen, as well as infection, very low Apgar scores, deaths in the first four weeks and cerebral palsy. Cerebral palsy is a lifelong condition that affects movement and is usually diagnosed in early childhood.

The Swedish team followed 1,962 mothers and their children from the Biology, Affect, Stress, Imaging and Cognition (BASIC) study in Uppsala, Sweden, a research project on mothers' mental health around pregnancy [4][14]. The children were followed in its sister project, U-BIRTH (Uppsala Birth Cohort) [15]. In this group, 726 mothers (37%) had an epidural. Parents filled in a standard questionnaire about their child's behaviour, such as worries, sadness, attention and aggression, when the children were 18 months, 6 years and 11 years old. The Swedish study was published a few months before the Scottish one, and the Scottish researchers describe it as reassuring about behaviour but not designed to look at serious newborn illness [3]. The two studies therefore fit together like two halves of a picture.

What the researchers found

In Scotland, serious brain-related problems in newborns were rare. They affected about 7 in every 10,000 babies whose mothers had an epidural and about 9 in every 10,000 babies whose mothers did not [3]. After the researchers accounted for differences between the mothers, such as age, health, whether this was a first baby and whether labour was induced, there was no meaningful difference between the groups. The same was true for newborn infections, very low Apgar scores, newborn deaths and cerebral palsy. Results were similar for babies born early, for mothers with higher-risk pregnancies and for every type of birth, including caesarean.

In Sweden, children of mothers who had an epidural scored slightly higher on the behaviour questionnaire at 18 months, by less than 2 points on a questionnaire of 99 questions [4]. Higher scores mean more behaviour difficulties. Once the researchers took account of the mother's age, her emotional resilience, any long-term inflammatory conditions, her fear of childbirth and the length of labour, this small difference disappeared. There was no difference at 6 or 11 years.

Why the first impressions can be misleading

Both studies show the same important pattern. Women who have epidurals are different, on average, from women who do not. They are more often having their first baby, more often have labour started artificially (induced), more often have long labours, and more often need help with forceps, suction or a caesarean. In the Swedish study they were also more likely to report fear of childbirth [3][4]. Each of these factors can affect a baby in its own right. When the researchers took them into account, the apparent differences went away.

This works in both directions. In Scotland, babies of mothers with epidurals at first seemed less likely to die in the first month. That was also explained by differences between the groups, so the studies do not show that epidurals protect babies either [3].

How sure can we be?

No study is perfect. The Scottish records did not include the mother's temperature in labour, so the researchers could not check babies whose mothers developed a fever separately. A mother with a fever in labour will still have her baby checked carefully for infection, whatever the cause. Very small increases in rare problems cannot be completely ruled out, and the study was mostly of white women in a country where fewer women have epidurals than in some others. The journal later published a correction to the Scottish paper that we were not able to read. The numbers in this article come from the version first published in July 2026.

The Swedish families were mostly highly educated and Swedish-speaking. The researchers also tested whether some natural immune proteins in the mother's blood late in pregnancy might change the picture. They found hints for two of these proteins, but this involved only 61 mothers, and the researchers say it is preliminary [4]. It is not something families need to act on.

What this means for families

If you are planning your birth, these findings mean you can choose pain relief based on what is right for you, without worrying that an epidural will harm your baby's brain, health or later behaviour. Epidurals have also been linked to fewer serious complications for mothers in Scotland [16]. Women in poorer areas of Scotland have been less likely to receive one [17], and the Scottish researchers argue that every woman should have fair access to this choice [3].

If your baby needed neonatal care after a birth with an epidural, or your child has since been diagnosed with cerebral palsy, autism or behaviour difficulties, it is natural to look for a reason. This research, together with the earlier family studies on autism [11], suggests the epidural is very unlikely to be the cause.

What researchers are working on next

Scientists would still like to understand fever in labour better, by linking mothers' temperatures, the length of time an epidural was used and the health of their babies. They also want to repeat these studies in more diverse communities and in countries where most women have epidurals, and to test the early immune-protein findings in much larger groups. For now, the message from two careful studies in two countries is clear and reassuring.

References

  1. Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;5(5):CD000331. doi:10.1002/14651858.CD000331.pub4 ↩
  2. Weinstein ER, Aaronson J, Abramovitz SE, McCullough D, Gotian R, White RS. Patients' perspectives on pain relief during childbirth and labor epidurals: a pilot qualitative study among women who chose to deliver without neuraxial labor analgesia. Int J Obstet Anesth. 2025;61:104294. doi:10.1016/j.ijoa.2024.104294 ↩
  3. Kearns RJ, Kyzayeva A, Singh S, Lawlor DA, Shaw M, Nelson S. Epidural analgesia in labour and neonatal and childhood outcomes: national population based cohort study. BMJ. 2026;394:e343320. doi:10.1136/bmj-2026-343320 ↩
  4. Asif S, Tu HF, White RA, et al. Labour epidural analgesia and early childhood behavioural outcomes: the moderating role of maternal mental health and pro-inflammatory cytokines. Anaesthesia. 2026;81(8):1079-1090. doi:10.1111/anae.70203 ↩
  5. Morton S, Kua J, Mullington CJ. Epidural analgesia, intrapartum hyperthermia, and neonatal brain injury: a systematic review and meta-analysis. Br J Anaesth. 2021;126(2):500-515. doi:10.1016/j.bja.2020.09.046 ↩
  6. Patel S, Ciechanowicz S, Blumenfeld YJ, Sultan P. Epidural-related maternal fever: incidence, pathophysiology, outcomes, and management. Am J Obstet Gynecol. 2023;228(5S):S1283-S1304.e1. doi:10.1016/j.ajog.2022.06.026 ↩
  7. Qiu C, Lin JC, Shi JM, et al. Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring. JAMA Pediatr. 2020;174(12):1168-1175. doi:10.1001/jamapediatrics.2020.3231 ↩
  8. Wall-Wieler E, Bateman BT, Hanlon-Dearman A, Roos LL, Butwick AJ. Association of Epidural Labor Analgesia With Offspring Risk of Autism Spectrum Disorders. JAMA Pediatr. 2021;175(7):698-705. doi:10.1001/jamapediatrics.2021.0376 ↩
  9. Mikkelsen AP, Greiber IK, Scheller NM, Lidegaard Ø. Association of Labor Epidural Analgesia With Autism Spectrum Disorder in Children. JAMA. 2021;326(12):1170-1177. doi:10.1001/jama.2021.12655 ↩
  10. Straub L, Huybrechts KF, Mogun H, Bateman BT. Association of Neuraxial Labor Analgesia for Vaginal Childbirth With Risk of Autism Spectrum Disorder. JAMA Netw Open. 2021;4(12):e2140458. doi:10.1001/jamanetworkopen.2021.40458 ↩
  11. Hegvik TA, Klungsøyr K, Kuja-Halkola R, et al. Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder: a cross-national cohort study of 4.5 million individuals and their siblings. Am J Obstet Gynecol. 2023;228(2):233.e1-233.e12. doi:10.1016/j.ajog.2022.08.016 ↩
  12. Kearns RJ, Shaw M, Gromski PS, Iliodromiti S, Lawlor DA, Nelson SM. Association of Epidural Analgesia in Women in Labor With Neonatal and Childhood Outcomes in a Population Cohort. JAMA Netw Open. 2021;4(10):e2131683. doi:10.1001/jamanetworkopen.2021.31683 ↩
  13. Cornet MC, Kuzniewicz MW, Scheffler AW, et al. Epidural Analgesia During Labor and Neonatal Hypoxic-Ischemic Encephalopathy. JAMA Netw Open. 2024;7(9):e2433730. doi:10.1001/jamanetworkopen.2024.33730 ↩
  14. Axfors C, Bränn E, Henriksson HE, et al. Cohort profile: the Biology, Affect, Stress, Imaging and Cognition (BASIC) study on perinatal depression in a population-based Swedish cohort. BMJ Open. 2019;9(10):e031514. doi:10.1136/bmjopen-2019-031514 ↩
  15. Tu HF, Fransson E, Kunovac Kallak T, Elofsson U, Ramklint M, Skalkidou A. Cohort profile: the U-BIRTH study on peripartum depression and child development in Sweden. BMJ Open. 2023;13(11):e072839. doi:10.1136/bmjopen-2023-072839 ↩
  16. Kearns RJ, Kyzayeva A, Halliday LOE, Lawlor DA, Shaw M, Nelson SM. Epidural analgesia during labour and severe maternal morbidity: population based study. BMJ. 2024;385:e077190. doi:10.1136/bmj-2023-077190 ↩
  17. Halliday L, Shaw M, Kyzayeva A, Lawlor DA, Nelson SM, Kearns RJ. Socio-economic disadvantage and utilisation of labour epidural analgesia in Scotland: a population-based study(†). Anaesthesia. 2024;79(5):473-485. doi:10.1111/anae.16236 ↩