Almost half of women giving birth in Ireland use epidural pain relief, according to a new global study which reveals that fear, lack of support, and hospital staffing can have greater influence on the use of the injected analgesic than a woman’s level of discomfort.
Increasing epidural rates globally are influenced by “industrialised” maternity systems which are failing to give women adequate support, according to Dr Elizabeth Newnham, Ussher assistant professor in Midwifery at Trinity College Dublin and co-author of Towards the Humanisation of Birth: A study of epidural analgesia and hospital birth culture.
Drawing on research conducted by authors in Australia, which involved observations of care delivered in a maternity hospital as well as interviews with 16 women over the course of their pregnancies, the study explores the personal, social, cultural and institutional influences on women in deciding whether or not to use pain relief in labour.
Approximately 40% of women in Ireland use epidurals and this figure increases in some hospitals and for women having their first babies. While epidural analgesia is effective at covering the pain of labour, research has shown it does not necessarily increase birth satisfaction, Dr Newnham said.
It has also been shown to interfere with normal labour, increase the risk of instrumental birth, and decrease the likelihood of successful breastfeeding. Women are not always informed of these risks when choosing an epidural, Dr Newnham added.
Despite these risks, epidural analgesia has been promoted as a safe technology in maternity care, because labour ward practices are embedded in a scientific discourse that prioritises and promotes technology use, according to Dr Newnham.
“Our research identified a fundamental paradox at the heart of modern maternity care. Practices that fit within the medical paradigm, such as epidural use or induction of labour, are pronounced safe even though they might, in fact, carry some risk, while practices that support physiological birth, such as water immersion and mobilisation, which have minimal side-effects, are treated as either inherently risky or somewhat ridiculous.”
While pain relief should always remain an option, it should not necessarily be viewed as the most important issue for women as they approach birth, says Dr Newnham.
“Women in our study expected to feel some pain, and most were either ambivalent towards it, or even welcoming of pain as part of the rite of passage to motherhood.”
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