Archive for July 15th, 2009

What man would be brave enough to suggest that the pain of labour is ‘a good thing’? Dr Denis Walsh, that’s who. Now the doctor title may be slightly misleading as, rather than being a medical ‘doctor’ the title is a PhD, he is actually a midwife, admittedly an extremely senior practitioner, but midwifery is his profession, even if he is ‘not able to provide midwifery care at this time’ (NMC register). He is now also the cause of huge discussions everywhere, ranging from a well-constructed defence of his opinion by Feminist Philosophers to a series of expletives, tempered with some thoughtful comments, on the Mumsnet forum.

What do I think? I think that epidurals are over-used. That they do adversely affect the progress of labour. That they change, what for 70% of women is a normal, physiological process, into a medical event. That the use of epidural anaesthesia increases the risk of an instrumental delivery. That the opiate used in the epidural passes into the woman’s blood stream and so across the placenta to the baby and may affect breastfeeding.

So now I have stated my thoughts about epidurals BUT I would never deny a woman her choice of an epidural, in fact there are times when I actually advocate the use of epidurals in labour. What I do attempt to do is support the woman in normal labour, to encourage her to accept that the pain of the contractions is not a sign that something is abnormal but, if she still wants the epidural, then she gets one.

I get annoyed when I hear women say that they don’t want pethidine because ‘it affects the baby but an epidural doesn’t’. Rubbish. Even before I read the research suggesting that epidurals adversely affect breastfeeding I was only too aware that having an epidural increased the chance that baby would be delivered by a ventouse or forceps, both of which are capable of causing severe physical damage to baby. How about the woman? Yes she will probably have a pain-free labour (not all epidurals work though). Labour will be longer, but that’s not a problem, for her, if she can’t feel anything, might distress baby though. She may not be able  pass urine, her bladder may become overful and obstruct baby’s head descending, no bother though as she can always have a cathater, but that does run the risk of giving her a urinary tract infection (cystitis). It’s more likely that she will need an episiotomy, but at least she won’t feel it, or the stitches, until the epidural wears off. The epidural may cause her blood pressure to fall dramatically, but her feeling faint and sick as a result, like the fall in baby’s heartrate, will be sorted out quickly by the intravenous fluids being increased and rolling her onto her left-side. The woman’s temperature may well rise as a result of the drug used in the epidural, but the staff can’t say definitely that the drug is the cause so the treatment has to be as if there is an infection present. The woman having a raised body temperature may also cause the unborn baby to demonstrate an increase in heartrate, if this persists then the medics will wish to investigate further and fetal blood sampling may be required. Following the birth the baby may well have to undergo investigations to rule out infection or, there may be a decision to use intravenous antibiotics prophylactically.

There it is then. If you hear, or have heard, of a midwife refusing a woman an epidural it wasn’t me, but if the story entailed a midwife trying to encourage a woman to cope without one it may well have been me as I have seen all of the above too many times to believe that epidurals are the innocent pain reliever many would like you to believe they are.

If anyone would like to read more from Denis Walsh about epidurals this  ‘Zephrina Veitch Lecture’ is great.

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