No labouring of point on use of epidurals

Link The use of epidurals in Ireland during labour has roughly doubled over the past 20 years. “This development isn’t a good thing. Because of the increased risk of potential complications during childbirth, administering an epidural during labour is not only undesirable — it’s also often unnecessary.”

That is the message from Dr Denis Walsh, Associate Professor of Midwifery at the University of Nottingham, who says a more naturalistic approach to labour-pain management should be considered.

... “There’s a physiological purpose to labour pain; it’s a natural state rather than a problem. So normal labour shouldn’t need to be treated as a pathology,” said Dr Walsh.

“Administering an epidural can interfere with the body’s natural responses. During labour the body releases endorphins, which not only affect the state of consciousness, but also stimulate movement. Studies have shown that walking and increased physical activity during labour can assist in the process.” An epidural, in most cases, requires that a woman remain in bed.

... Epidurals have been shown to increase the duration of labour, and cause a decrease in oxytocin. Additionally, the baby may become malpositioned to transverse or posterior.

Studies have shown a correlation between the use of epidurals and an increase in the use of forceps to aid delivery, by up to 40 per cent, and some recent research has indicated that epidural anaesthesia can lower prolactin levels in response to breastfeeding in the days following birth.

... women need to be presented with all the information regarding epidurals before undergoing anaesthesia. ... “Some 50 per cent [of anaesthetists] didn’t mention the risk of intervention with forceps. The need to communicate all the risk factors is essential.

“... if a woman is in severe distress, or there are complications, of course it should be administered.

“But during a normal birth, there are other ways to make the mother more comfortable,” ...

“... it’s the support given to the mother, not pain management, that’s the more significant factor in a positive experience of childbirth. Key to a positive experience is one-to-one support from a midwife.

“... One-to-one support has been shown to reduce the number of Caesareans carried out, and reduces the number of epidurals. A midwife can help in pain management both physically, for instance [with] massage, and psychologically, by offering emotional support.”

Dr Walsh suggests that access to water-immersion facilities ... could reduce the need for epidurals. There is evidence to show a correlation between water immersion during the first stage of labour and a reduction in the use of epidurals ...

It's my experience that women who are well prepared for labour and who are supported in their labours with one-to-one midwifery care, do not need epidurals. A mere 3% of women who use my services choose an epidural for their labours and 80% use no pain relief at all.

Melissa Maimann, Essential Birth Consulting