THE PRICE OF PAIN RELIEF

Giving birth can be both one of the most wonderful and one of the most agonisingly painful experiences any human can have. No man can completely understand what the women we love have to go through to bring our children into the world, but you don’t have to experience it first hand to know that even a straightforward and quick labour with no complications is a shattering experience and a bad one is beyond description.

I have always found it amazing that some “natural birth” fanatics try as hard as they do to persuade women not to use pain relief during birth. Where there are genuine medical concerns about particular methods of pain relief I understand it. But people who argue against anaesthetics on the grounds that they stop people from having the whole experience of birth completely horrify me. It is the sort of argument you would expect from the Marquis de Sade on acid.

I am strongly opposed to the proposal from Education and Research Committee of the National College of Midwives to charge women giving birth in NHS hospitals for epidurals “unless there is a medical need for them.” Like many proposals which at first sight appear to be completely insane the arguments for and against this are more complex than is immediately apparent. But although there is a real issue this proposal absolutely is not the way to address it.

The reason why some midwives are arguing for a reduction in the number of epidurals is that studies suggest women who have this particular form of pain relief may spend longer pushing the baby out of the birth canal and are up to 40% more likely to need some other form of intervention. For example they may need a forceps delivery which can bruise the child’s head. So there is an argument for encouraging wider use of alternative forms of pain relief.

However, discouraging epidurals by charging for them is an appalling idea which would be both unjust and utterly counterproductive. For a start, wealthier patients would pay for anything which they perceived as reducing pain no matter how much it costs, and this policy might actually encourage those women with incomes above the poverty level to think of an epidural as a powerful form of pain relief and ask for one. On the other hand, those vulnerable women who are affected by poverty might be afraid to ask for pain relief even if they really needed it for fear of being charged for an “unnecessary epidural.” Any policy which might result in the poorest members of society going through agonising pain while being afraid of the cost if they ask for help would be outrageous and utterly unacceptable.

Whether pain relief is provided and of what kind is not just the responsibility of the mother, it is also a matter on which the taxpayer is paying for the professional advice and expertise of the midwife and at least two doctors, the anaesthetist and obstetrician. If there are medical issues affecting the form of pain relief to be used it is the professionals’ responsibility to ensure that those issues are properly taken into account. They can, should, and in my experience, do explain to the expectant mother the advantages of the various different forms of pain relief available.

Recent surveys by Mother and Baby magazine found that only 5% of women have a “completely natural” birth with no intervention or pain relief: 23% have a planned or emergency caesarean. 38% of women have an epidural. These percentages did not change between surveys in 2002 and 2004. I have seen it suggested elsewhere that the percentage of births with an epidural is about 20%. Either way it would appear that a very substantial proportion of mothers do ask for pain relief but go for one of the other options rather than an epidural, and the proportion given an epidural does not appear to be increasing.

If, and I repeat if, there is convincing evidence that large numbers of women are asking for or being given epidurals without medical need – then procedures for advising on and deciding on pain relief should be reviewed. But it would be wholly wrong to put the blame on the mothers or to introduce charging.

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Chris Whiteside said…
The above posts were deleted because all of them were a) off topic, and b) adverts

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