A study in the latest edition of the Irish Medical Journal looking at practice across 16 Irish maternity units found that in half of them, risks such as paralysis and permanent nerve damage were not discussed with the patient. Just six units discussed the risk of epidural abscess and even fewer (three) discussed the risk of meningitis.
Most did, however, discuss the more minor risks such as headache (93.8% of respondents), partially/not working epidural (93.8%), drop in blood pressure (87.5%), and temporary backache/local tenderness (75%).
The study, carried out by members of the anaesthesia department at the Mid-western Regional Hospital in Limerick, also evaluated whether verbal or written consent was obtained prior to giving an epidural — a form of anaesthetic used especially in childbirth to produce loss of sensation below the waist.
It found that:
* In 10 units, written consent was obtained;
* In the remaining six units, verbal consent was obtained;
* Consent was documented in all units on either a specific consent form for epidural (75%) or in the patient’s notes (25%).
When obtaining consent from a woman with poor English, the majority of respondents (93.7%) reported that they either got a family member or friend to translate or used an official translator.
However, one respondent reported that they would insert the epidural without consent if a translator was not available.
Nobody reported that they would abandon the procedure.
The study’s authors said the results showed there was “major variation across Ireland both in which risks are discussed with women in labour and what risks are quoted”.
Currently, there is no national standard regarding epidural consent in Ireland.
The lead anaesthetist in each of the 16 units was asked if they felt there should be a standardised national epidural information leaflet detailing the benefits and risks of epidural analgesia, for use in all hospitals in Ireland.
Fourteen of the respondents were in favour.
The study’s authors said it has been shown that women in labour would prefer to be informed of all risks associated with epidural analgesia and that non-disclosure of the risks is unacceptable to them. “We cannot morally refrain from discussing the more serious risks of epidural insertion with patients,” they said.
Dr Aoife Hegarty, one of the authors, said their survey showed “overwhelming support for the use of a national standardised information card” along with documentation in the patient’s notes that such a card had been read by the patient which “would also serve as medico-legal evidence for informed consent”.
Those who took part in the survey agreed that the antenatal clinic would be the best environment in which to give women information about epidural analgesia, on the grounds that women would prefer to be informed about it prior to the onset of labour.
The risks of serious damage as a result of epidural are low, with persistent nerve damage at one in 13,000; epidural abscess at one in 50,000; meningitis at one in 100,000; and severe injury, including paralysis, at one in 250,000.