Epidurals

Epidurals are a widely used method of pain relief in the West, with over 50% of American mothers opting for one, with more women requesting one than for any other form of pain relief. (Americanpregnancy, 2017) Like the other medical procedures I’ve looked at, epidural rates are also increasing; in fact they doubled from 1989 to 2008 in the UK, going from 17% to 33%. (Walsh, 2009). This isn’t surprising given the effectiveness in pain relief- only 1 in 100 women require additional pain relief after an epidural, compared to 28 out of 100 women when other pain relief options are used (PubMed Health, 2012).

However, there is considerable opposition to the widespread use of epidurals, both from midwives and members of the natural birth movement, as many argue that epidurals lead to a ‘snowball effect’, as epidurals can lead to further intervention being necessary. Dr Sarah Buckley describes this as a ‘cascade of intervention’ and says that epidural often leads to women having a slower labour, caused by the epidurals effect on the pelvic floor muscles, which can reduce a first time mother’s chance of a natural birth to less than 50%. The slowing of the pelvic floor muscles not only leads to a slower labour but puts a baby more at risk of dystocia (where the baby is ‘wedged’ in an awkward position), and this leads to an increased risk of the use of forceps, or a caesarean section. The use of forceps often means that an episiotomy is necessary, where the perineum is cut to make more room. This then requires stitches, which can take up to 4 weeks to heal. (Buckley, 2016). All this increased intervention can leave a mother feeling powerless, and can take away from the joy of childbirth, as well as increasing risks when caesarean births and episiotomies are involved.

Despite this, a key value of our NHS is patient choice. It is understandable why a woman would choose to forgo the pain of labour when we have the technology available to do so. If this choice is informed- the mother is aware of all the risks- women absolutely should be able to take this option. However, it is questionable how much of this is a choice given the high levels of scrutiny women face for their birth decisions- for example there was a lot of controversy in the tabloids about Kate Middleton considering a home birth; for example, the Daily Mail said ‘the Duke and Duchess decided not to take the risk last time. A similar request with the third baby would be more acceptable’, implying that home birth is not only risky, but also an ‘unacceptable’ choice in the eyes of the public (Griffiths, 2017). Can women truly make a free choice when they are under scrutiny? To add to this, even if women are receiving all the information from their midwife, the onslaught of misinformation and scaremongering from the media in the west may counteract this. In an article about epidurals, the Guardian describes the ‘agony of childbirth’ in its opening paragraph (Campbell, 2009). In online forums many women also complain about only hearing negative birth stories from the women around them, contributing to a fear of pain and of childbirth. (NetMums, 2011). Although none of this means that women should have the choice of epidural taken away from them, it does raise the issue that many women cannot make an informed, non-biased choice. Western society perceives birth as dangerous, painful, and an event to be medicalised, a statement which is backed up by my survey, and countless women who are terrified of this natural process.