To investigate the associations between the use of epidural analgesia (EA) and intrapartum care, labour, birth and neonatal outcomes in uncomplicated pregnancy low-risk women, to inform evidence-based intrapartum practices and support informed maternal choice.

Retrospective cohort study.

Single maternity hospital in Northern Italy.

A total of 3406 uncomplicated pregnancy low-risk women who gave birth between 2019 and 2023 were included. Participants were grouped according to whether they received EA (n=417) or not (n=2989).

Labour progression, intrapartum care practices, maternal and neonatal outcomes were evaluated according to exposure to EA. Associations between EA and the study outcomes were assessed using descriptive and inferential statistics and multivariable logistic and linear regression analyses, adjusted for maternal age, parity and other outcome-specific confounders.

Women receiving EA experienced higher rates of prolonged first and second stage of labour (adjusted OR (aOR) 24.3 and 5.0, 95% CI 17.8 to 33.6 and 3.8 to 6.6, respectively), amniotomy and oxytocin use (aOR 7.7 and 17.8, 95% CI 5.7 to 10.6 and 12.9 to 24.6, respectively), caesarean section (aOR 7.2, 95% CI 3.1 to 17.1), lithotomy position at birth (aOR 2.3, 95% CI 1.7 to 3.0) and urinary retention (aOR 6.0, 95% CI 3.1 to 11.5). No differences were observed in neonatal outcomes.

In uncomplicated pregnancy low-risk women, EA during active labour was associated with increased rates of clinical interventions and altered labour patterns, with no differences in neonatal outcomes. These findings underscore the importance of the midwife’s role in promoting physiological labour while ensuring effective pain management.