Epidural Analgesia in Labor: A Nationwide Evaluation of Utilization in Germany

Lumbar epidural anesthesia (LEA) is considered the gold standard for the treatment of pain during vaginal delivery. Despite procedural advances and high maternal satisfaction in surveys, the extent of LEA utilization in Germany and its trend over time remain unclear.

We carried out a nationwide retrospective cross-sectional analysis of routine administrative data reported by German hospitals from 1 January 2014 to 31 December 2023. Births were identified by ICD-10 and OPS codes. The data set included all women in Germany who were admitted to a hospital for childbirth. The data analysis was descriptive, with subgroup stratification by mode of delivery. The primary endpoint was the use of LEA for delivery.

4.5 million out of 6.6 million deliveries (68%) were vaginal. LEA was used in 1.2 million deliveries (18.4% of the total), including 922 510 in vaginal deliveries (20.5% of all vaginal deliveries). Women who received LEA were younger on average (median age, 30 vs. 31 years). LEA utilization was relatively stable throughout the study period. Women undergoing vaginal delivery were more likely to receive LEA if they had documented pre-existing conditions or comorbidities.

The level of LEA utilization in Germany is stably low compared to other high-income industrialized countries. Better prenatal maternal education and standardized counseling on pain management options can raise awareness of this method of obstetrical analgesia and increase its use.