Are epidurals common in Europe? Understanding the regional variation in childbirth pain relief

September 29, 2025 •

4 min read

While the World Health Organization recommends epidurals for healthy pregnant women requesting pain relief during labour, the rate of use varies dramatically across Europe. Factors influencing this include local hospital practices, availability of anesthesiologists, and cultural attitudes toward pain management. Understanding these regional differences is crucial for expectant parents researching their options.

Quick Summary

The prevalence of epidural use for childbirth in Europe is far from uniform, exhibiting significant country-to-country variation driven by a complex mix of healthcare policy, cultural beliefs, and service availability. A woman's access to and decision to use epidural analgesia can depend heavily on where she gives birth, illustrating that there is no single answer for all of Europe.

Key Points

Significant Regional Differences: Epidural use in Europe is not uniform, with rates varying dramatically between countries due to different healthcare policies and cultural attitudes.
High vs. Low Usage Countries: Countries like France and Belgium have very high epidural rates (>80% and >60%, respectively), whereas rates in the Netherlands, Italy, and Germany are much lower and often vary by region and hospital.
Policy and Access: In some regions, limited availability of anesthesiologists can restrict access, even when the procedure is publicly funded, as seen in parts of Poland and southern Italy.
Cultural Influence: Attitudes toward childbirth pain and pharmacological intervention play a significant role in patient choice, with some cultures valuing a more 'natural' approach to labor.
Importance of Patient Dialogue: The wide variance in epidural access and use underscores the need for expectant parents to have open discussions with their healthcare providers about their preferences throughout pregnancy.
Patient Choice is Key: While policy and resources are major drivers, personal preferences, birth anxiety, and information access are all influential factors impacting an individual's decision.

Regional Variation: A Closer Look at European Epidural Rates

Unlike in the United States, where epidural use is widely prevalent, European epidural rates are highly inconsistent. A woman giving birth in France, for example, is far more likely to receive an epidural than one in the Netherlands or Italy. This stark contrast highlights that the availability and acceptance of epidural analgesia are deeply tied to national healthcare systems and societal norms.

Factors Influencing Epidural Uptake

Several key factors contribute to the wide variation in epidural use across Europe:

Healthcare Policy and Funding: In countries like Poland, despite being publicly funded, access is often limited by a shortage of anesthesiologists. In contrast, France and Belgium have high epidural rates, partly due to the procedure being a standard offering within their healthcare systems.
Cultural Attitudes: In some cultures, there may be a higher value placed on giving birth without pharmacological intervention, viewing pain as a natural part of the process. This is contrasted by countries where modern medicine is heavily integrated into the birthing experience.
Availability of Anaesthesiologists: The staffing levels at maternity wards play a direct role. Hospitals that have an anaesthesiologist available 24/7 are more likely to have higher rates of epidural use, whereas hospitals requiring an anaesthesiologist to be called from other parts of the hospital or from home may see lower rates.
Information and Education: The information provided to expectant mothers during pregnancy about pain relief options can influence their intentions and choices. In some regions, access to comprehensive information may be lacking, particularly for migrant or lower-income populations.

Country-Specific Examples

High Epidural Rate Countries

France: A 2016 report showed that 82% of women opted for an epidural, with some hospital rates even higher. The integration of epidural use into mainstream obstetric care has made it a common, and often expected, option.
Belgium: Epidural analgesia is the norm for many women in the Flemish part of Belgium, with some data suggesting use rates are among the highest in Europe. National guidelines recommend it as the most effective pain relief method.

Low and Variable Epidural Rate Countries

The Netherlands: While epidural rates are rising, they have historically been lower than in neighboring countries, partially due to a robust midwifery system and a higher rate of home births.
Italy: Significant regional disparities exist, with lower rates of access and use in the south compared to the north. Public monitoring of access is lacking in some areas.
Germany: Estimates suggest around 25% of births involve an epidural, but this figure can vary by hospital depending on staffing levels and the specific culture of the maternity ward.

The Importance of Patient Choice

With such varied practices, patient choice becomes a critical component of maternity care. A woman's birth plan and pain management preferences should be discussed openly with her healthcare providers throughout her pregnancy. Studies have shown that a woman's intention for epidural use can change over the course of pregnancy, emphasizing the need for ongoing dialogue. Factors like fear of childbirth pain, the opinion of her partner, and the healthcare provider's attitude all play a role in her final decision.

Comparison Table: Epidural Rates in Select European Countries


Country	Epidural Rates (approximate)	Key Factors
France	>80%	Standard obstetric practice, high availability.
Belgium	>60%	Recommended by national guidelines, high availability.
Sweden	~45%	Moderate rate, influenced by local hospital practices.
Netherlands	~30%	Traditionally lower due to strong midwifery tradition, but increasing.
Germany	~25%	Varies significantly by hospital staffing and philosophy.
Italy (North)	20-38%	Better access in northern regions, disparities remain.
Italy (South)	<10%	Poor access in many southern regions due to resource limitations.

Global Context and Future Directions

While Europe shows wide variations, other high-income countries like the United States generally have higher epidural rates. The World Health Organization's recommendation supports the use of epidurals for those who request it, affirming its role as a safe and effective pain relief option.

The ongoing conversation in Europe is focused on ensuring equitable access to pain relief, especially for vulnerable populations and those in under-resourced areas. Efforts by organizations like the European Society of Anaesthesiology and Intensive Care (ESAIC) to standardize best practices for epidural management demonstrate a commitment to improving safety and consistency of care across the continent.

Conclusion

The question, "Are epidurals common in Europe?" has no simple yes-or-no answer. The use of epidural analgesia varies significantly from country to country, shaped by a complex interplay of public health policy, cultural expectations, and regional healthcare resources. For anyone navigating the European maternity care system, understanding these national and local variations is key to a well-informed and positive birthing experience.

For more information on maternity care and birth statistics across Europe, you can visit the official Eurostat website, a reliable resource for European Union statistics. Eurostat fertility statistics

Frequently Asked Questions

No, an epidural is not readily and universally available across Europe. Access and availability depend heavily on the country's healthcare system, with significant differences in rates and access between countries and even within regions of the same country.

France and Belgium are among the European countries with the highest epidural rates. France reported rates over 80%, while Belgium also has very high uptake, often citing national guidelines that recommend it as effective pain relief.

Lower rates can be influenced by a variety of factors, including a strong cultural preference for unmedicated birth, limited staffing of anesthesiologists in certain hospitals, and the prioritization of alternative pain relief methods, as seen in countries like the Netherlands and parts of Italy.

Yes, cultural beliefs and attitudes toward pain and childbirth significantly impact epidural use. Some cultures may emphasize natural birth and pain endurance, while others readily accept modern medical interventions for pain management.

Epidural coverage varies by country. In many European countries with public healthcare systems, the procedure is covered. However, as in Poland, coverage doesn't always guarantee immediate access due to resource limitations, such as a shortage of available anesthesiologists.

Overall, epidural rates are generally lower in many European countries compared to the United States, where use is very common. However, some European countries like France and Belgium have comparable rates to the US.

To ensure access, you should discuss your pain management preferences with your healthcare provider early in your pregnancy. It is also beneficial to research the specific policies and staffing of your local maternity hospital, as these can vary even within the same country.