UK: Mothers face crackdown on epidural births

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Mothers face crackdown on epidural births Sarah-Kate Templeton

HOSPITALS are under attack from staff and patients for trying to stop large numbers of women from having epidurals during birth ... The controversial restrictions ... aim drastically to reduce the number of women having epidurals, caesareans or other artificial procedures to 40%.

In some hospitals the proportion of first-time mothers now having epidurals is far higher at 60%.

The targets are contained in a guidance document, Making Normal Birth a Reality, drawn up by the National Childbirth Trust (NCT) with the backing of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists.

The document argues that mothers and doctors are too ready to resort to medical intervention and that any such procedure brings risks ...

Professor James Walker, a consultant obstetrician at Leeds Teaching Hospitals NHS Trust, said ... “Epidurals should not be done without reason; they should be kept to a minimum. There are some women, however, who require an epidural because they cannot cope with the pain in any other way.”

Belinda Phipps, chief executive of the NCT, argues, however, that there are medical reasons for trying to restrict the procedure. An epidural, she says, is more likely to result in a baby being delivered with forceps or a ventouse - a suction device - because the mother is less able to push the baby out.

A British review ... found the procedure prolonged labour and increased the chance of further medical intervention by 40%.

When I did my midwifery degree, midwives were supported by management and other midwives to support women through natural labour, if that was their intention. We all know that at some point in labour, many women want something, anything - epidural, caesarean, whatever! But that is where the skill of the midwife really comes in. It is about calming the woman, helping her to change position, getting her a hotpack, moving into the bath, talking calmly to her, surrounding her with love and supportive people - these "interventions" are both safe and effective.

Epidurals have been demonstrated to have complications associated with their use: longer labour leading to augmentation (breaking waters or using an infusion of syntocinon), fetal distress from augmentation, malpositioning of the baby (such as posterior), back ache, spinal tap, infection, increase in the caesarean rate as a consequence of being continuously monitored, and forceps or a vacuum birth because of the woman's inability to feel to push.

With all these consequences of epidurals, is there any question why there's a push towards normal birth?

It does, however, beg the question - who should decide what intervention a woman has in her bitrh? Surely it's the woman's choice, and hers alone. I agree with this comment, and happily support women through hospital births where they may elect to have an epidural. However, I tend to find that a well-informed woman who has attended comprehensive childbirth education and perhaps Calmbirth classes, will be far less likely to choose an elective epidural.

Smriti Singh, mentioned in the article, alludes to the potential for birth trauma related to the pain of birth. Most quality research points to their being less birth trauma for women who have experienced natural birth, than women who have experienced interventionist birth. Mitigating factors are things such as birth preparation, having an awareness and understanding of all available options, and the presence of a supportive person during your birth.

Melissa Maimann, Essential Birth Consulting.