Epidural or Spinal Anesthesia Use for Singleton Vaginal Deliveries: United States, 2016−2024

NCHS Data Brief No. 553, March 2026

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Claudia P. Valenzuela, M.P.H., and Michelle J.K. Osterman, M.H.S.

Introduction

Epidurals and spinal anesthesia are used to treat pain during labor. The American College of Obstetricians and Gynecologists recommends that pain relief be administered to laboring women upon request (1). Studies have found that women who received no pain treatment experienced increased pain and were more likely to have a cesarean delivery compared with those who received an epidural (2). National birth certificate data on epidural or spinal anesthesia use during labor are available beginning in 2016. This report shows trends of epidural or spinal anesthesia use for singleton vaginal deliveries from 2016 to 2024 and changes by selected maternal characteristics.

Trends

• The percentage of mothers with a singleton vaginal birth who used epidural or spinal anesthesia increased 8% from 2016 (69.8%) to 2024 (75.4%) (Figure 1, Table 1).
• The percentage of mothers who used epidural or spinal anesthesia increased 7% from 2016 to 2021 (74.7%), decreased 1% from 2021 to 2022 (74.3%), and then increased 1% from 2022 to 2024.

Age

• The use of epidural or spinal anesthesia increased for all maternal age groups between 2016 and 2024, ranging from a 7% increase for mothers 20-24 (from 72.3% to 77.7%) to 12% for mothers 45 and older (from 63.2% to 70.7%) (Figure 2, Table 2).
• For both years, the percentage of epidural or spinal anesthesia use generally decreased with increasing maternal age, although the percentages in each year were similar for mothers 40-44 and 45 and older.
• In 2024, epidural or spinal anesthesia use ranged from a low of 70.3% for mothers ages 40-44 and 70.7% for mothers 45 and older to a high of 81.3% for mothers younger than 20.

Race and Hispanic origin

• The percentage of mothers who used epidural or spinal anesthesia increased for all race and Hispanic-origin groups. Use ranged from a 5% increase for both Native Hawaiian or Other Pacific Islander non-Hispanic (subsequently, Native Hawaiian or Other Pacific Islander) mothers (from 55.2% to 58.0%) and White non-Hispanic (subsequently, White) mothers (72.7% to 76.3%) to a 17% increase among American Indian and Alaska Native non-Hispanic (subsequently, American Indian and Alaska Native) mothers (from 56.8% to 66.2%) (Figure 3, Table 3).
• In 2024, the use of epidural or spinal anesthesia was highest among Asian non-Hispanic (subsequently, Asian) mothers (79.7%) and lowest among Native Hawaiian or Other Pacific Islander mothers (58.0%).

Source of payment

• The use of epidural or spinal anesthesia increased 6%-9% among mothers covered by Medicaid (from 67.8% to 73.8%), private insurance (74.3% to 80.5%), and other sources of payment (69.6% to 74.0%) (Figure 4, Table 4).
• The use of epidural or spinal anesthesia decreased 4% among mothers who self-paid for their deliveries (from 43.0% in 2016 to 41.2% in 2024).
• In 2024, the use of epidural or spinal anesthesia was highest among mothers covered by private insurance and lowest among mothers who self-paid for their deliveries.

State of residence

• From 2016 to 2024, the use of epidural or spinal anesthesia increased in 44 states and the District of Columbia, decreased in 2 states (Alabama and Utah), and did not change significantly in 4 states (Montana, Nevada, New York, and South Dakota) (Figure 5, Table 5).
• In 2024, the use of epidural or spinal anesthesia ranged from 50.6% in Alaska to 85.0% in Louisiana.

Summary

From 2016 to 2024, the percentage of mothers having a singleton vaginal birth who used epidural or spinal anesthesia for pain relief during labor increased 8%, from 69.8% to 75.4%. Increases in the use of epidural or spinal anesthesia occurred across all maternal age groups (ranging from 7% to 12%) and all race and Hispanic-origin groups (ranging from 5% to 17%). The percentage of mothers who used epidural or spinal anesthesia increased among those covered by Medicaid, private insurance, and other sources of payment, but decreased among mothers who self-paid for their deliveries. Epidural or spinal anesthesia use increased in 44 states and the District of Columbia, decreased in 2 states, and was essentially unchanged in 4 states from 2016 to 2024.

Definitions

Epidural or spinal anesthesia: Administration of a regional anesthetic to the mother to control the pain of labor. Pain medication is injected into the lower region of the spine to provide regional pain relief to the lower body. The definition is limited to mothers who undergo labor regardless of method of delivery. Anesthesia administered solely for surgery, such as cesarean delivery, is excluded.

Principal source of payment for the delivery: The principal form of payment for the delivery at the time of delivery. The U.S. Standard Certificate of Live Birth lists four options in a checkbox format: 1) private insurance, 2) Medicaid, 3) self-pay, and 4) other.

• Private insurance: Providers such as Blue Cross Blue Shield and Aetna.
• Medicaid: Includes state programs comparable with Medicaid.
• Self-pay: No third-party payer identified; generally considered uninsured.
• Other: Includes Indian Health Service, TRICARE (formerly known as CHAMPUS), other government programs, and miscellaneous payment sources.

Data source and methods

This report uses data from the National Vital Statistics System's natality data file. The vital statistics natality file is based on information from birth certificates and includes information for all births occurring in the United States (3). This report focuses on singleton births in vaginal deliveries. Cesarean deliveries were excluded because all such deliveries require anesthesia. Data are also restricted to singleton births only because multiple births are at higher risk of preterm birth and low birthweight (4), which may influence the receipt of epidural or spinal anesthesia. The race and Hispanic-origin groups shown in this report follow the 1997 Office of Management and Budget standards and differ from the bridged-race categories in reports before 2016 (5). These groups are the six largest race and Hispanic-origin groups: Hispanic and the non-Hispanic American Indian or Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and White populations.

References to differences in percentages indicate that the differences are statistically significant at the 0.05 level based on a two-tailed z test. Computations exclude records for which information is unknown.

About the authors

Claudia P. Valenzuela and Michelle J.K. Osterman are with the National Center for Health Statistics, Division of Vital Statistics

References

1. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 209 summary: Obstetric analgesia and anesthesia. Obstet Gynecol. 2019 Mar;133(3):595-7.
2. Anim-Somuah M, Smyth RMD, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews. 2018 May;5(5):CD000331. DOI: https://dx.doi.org/10.1002/14651858.CD000331.pub4.
3. National Vital Statistics System. Revisions of the U.S. standard certificates and reports. 2019. Available from: https://www.cdc.gov/nchs/nvss/revisions-of-the-us-standard-certificates-and-reports.htm.
4. Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final data for 2023. Natl Vital Stat Rep. 2025 Dec;74(1):1-18. DOI: https://dx.doi.org/10.15620/cdc/175204.
5. Office of Management and Budget. Revisions to the standards for the classification of federal data on race and ethnicity. Fed Regist. 1997 Oct 30;62(210):58782-90.

Suggested citation

Valenzuela CP, Osterman MJK. Epidural or spinal anesthesia use for singleton vaginal deliveries: United States, 2016-2024. NCHS Data Brief. 2026 Mar;(553):1-12. DOI: https://dx.doi.org/10.15620/cdc/174650.

Copyright information

All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

National Center for Health Statistics

Carolyn M. Greene, M.D., Acting Director
Amy M. Branum, Ph.D., Associate Director for Science

Division of Vital Statistics

Paul D. Sutton, Ph.D., Director
Andrés A. Berruti, Ph.D., M.A., Associate Director for Science