Sunday, October 5, 2008

Routine epidural denied. Is this a problem?

A news item today discusses women in the UK being denied epidurals because of a lack of anaesthetists. Epidurals are a local anaesthetic injected into the epidural space in the spine near to the spinal cord, which provides numbing and therefore relief of pain in labour. This emotive article quotes the Vice President of the Royal college of Obstetricians saying that epidurals should be routine in birth.

There are clear associations between epidural anaesthetic and the need for other interventions in labour, such as instrumental birth with forceps or ventouse(suction cap applied to the babies head)or caesarean section.

The article sites the Cumberland Royal Infirmary as being particularly affected by this inability to provide epidural. It is not so strange then that the Cumberland Royal Infirmary has a lower level of intervention in childbirth compared with other local hospitals. Cumberland Infirmary has a 50% normal vaginal birth rate, Cresswell maternity has a 30.8% normal birth rate and Furness has a 44.4% normal birth rate. Normal vaginal birth leads to lower incidence of complications in the postnatal period for both mother and child. There are also fewer complications with following pregnancies. Do women want pain free birth at this price? What do women think about 'routine' epidural? How do staff support women to birth normally and without intervention if they expect every woman to have a epidural? How do they walk alongside women through the triumphant process of normal and natural labour and birth?

Do you have any thoughts or comments about this? Are women told enough about what to expect in childbirth and the effects of interventions such as Epidural?


Dot said...

When I was pregnant I read up on the 'cascade of intervention' and was keen not to have an epidural (and indeed I didn't). Routine epidural seems like a clearly bad idea, but on the other hand I am uneasy with the idea that women's choice should be removed in this matter. Women should neither be co-opted into having epidurals for their own good nor prevented from having them for their own good. They (we) should be informed of both the risks and benefits - because there obviously are benefits in epidural for women experiencing a painful and/or prolonged labour.

Dot said...

Sorry, additional comment: I felt the information leaflet I was given by the hospital about epidural actually minimised the risks involved. I got the impression I was being 'sold' the procedure. On the other hand, the midwives and physiotherapists who conducted the antenatal classes were keen to discourage us from automatically signing up for epidurals (though the classes were rather rushed and very crowded and formal, so I don't think there was adequate discussion of why this form of analgesia might often be a bad idea). This was in Ireland, where many women are having babies on a private or semi-private basis and would thus pay more for a labour with epidural (is it cynical of me to mention that?).

Carolyn said...

Thanks for these comments Dot. You raise a couple of very interesting points here. It is so important to give balanced information which states the facts so that people can truly make informed choices. It seems to be incredibly hard to find truly balanced information, so often with medical interventions such as epidural, the risks are played down. Why is this? These interventions are incredibly expensive on the health budget, they lead to other interventions which also increase the cost of childbirth. More intervention in childbirth does not lead to better outcomes for women and babies, unless it is medically necessary of course. Instead it leads to more problems for women and babies. I cannot support the idea that epidural in labour should be 'routine'. I need to blog some more about this and will do this very soon.

We are in the strange situation in most western societies where intervention in birth has passed the point of benefit to the mother and child and actually lead to more complications and problems for women and babies. In developing countries the opposite is true, necessary interventions are not available which also leads to poor outcomes for women and babies. Why can we not get the balance right?

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