Royal College of Midwives Conference
Next week the Royal College of Midwives are meeting in Torquay for their annual conference.
Almost all of us owe a tremendous debt of gratitude to the midwives who helped bring us into the world: I have of course no memory of the midwives who assisted at my own birth, but I have very positive memories both of those who assisted at the birth of my own children, and of those midwives I met while serving as a Health Authority member. In both cases I was impressed by their professionalism, knowledge, and common sense.
Obstetricians have the most glamorous role in delivering babies but, after the mother, midwives do most of the work, and the rest of us would do well to listen very carefully to what they have to say. Which makes the recommendations of the RCM conference on all aspects of birth, including pain relief, very important. I shall be watching what the conference says about Epidurals and other forms of pain relief with great interest.
Earlier this year the Education and Research Committee of the Royal College of Midwives recommended that women giving birth in NHS hospitals should be charged for epidurals “unless there is a medical need for them.” The press stated that this recommendation would debated at the forthcoming conference.
No man can fully understand what the women we love have to go through to bring our children into the world. But any man who is not totally devoid of sensitivity and has heard the cries of a woman in labour can grasp that even a straightforward and quick birth with no complications is a very intense experience for the mother, and a bad one is one of the most painful and traumatic things a human being can experience.
There is a range of views about pain relief during childbirth. When my wife was preparing to give birth both she and I were astonished at how hard people at one end of the spectrum try to persuade women not to use pain relief during birth. Some of the more extreme “natural birth” enthusiasts argue against anaesthetics on the grounds that they stop people from having the whole experience of birth. Both then and now this struck me as the kind of argument you would expect from the Marquis de Sade on acid.
However, that is not the basis of the proposals from the Education and Research Committee of the Royal College of Midwives, who were raising genuine medical concerns. They based their argument for a reduction in the number of epidurals on studies which suggest that 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 evidence-based argument for encouraging wider use of alternative forms of pain relief.
It is with some trepidation that I disagree with people who know far more about this issue than I do. However, although there is a real concern, charging is absolutely not the way to address it.
As I wrote a few months ago, discouraging epidurals by charging for them would be both unjust and counterproductive. Those who could afford it would pay for anything which they perceived as reducing pain regardless of cost, and this policy might better 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, vulnerable women who are affected by poverty might be afraid to ask for pain relief even if they really need 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 of asking for help would be completely unacceptable.
Whether pain relief is provided and of what kind is not just the responsibility of the mother, it is also a matter 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 different forms of pain relief available.
Recent surveys by Mother and Baby magazine in 2002 and 2004 found that only 5% of women have a “completely natural” birth with no intervention or pain relief. Of those who responded to both surveys, 23% had a planned or emergency caesarean and 38% of women had an epidural - and neither percentage increased between the 2002 and 2004 surveys. I have seen it suggested elsewhere that the percentage of births with an epidural is about 20%.
If these surveys are correct then a very substantial proportion of mothers do ask for pain relief but go for one of the other options rather than an epidural.
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.
Almost all of us owe a tremendous debt of gratitude to the midwives who helped bring us into the world: I have of course no memory of the midwives who assisted at my own birth, but I have very positive memories both of those who assisted at the birth of my own children, and of those midwives I met while serving as a Health Authority member. In both cases I was impressed by their professionalism, knowledge, and common sense.
Obstetricians have the most glamorous role in delivering babies but, after the mother, midwives do most of the work, and the rest of us would do well to listen very carefully to what they have to say. Which makes the recommendations of the RCM conference on all aspects of birth, including pain relief, very important. I shall be watching what the conference says about Epidurals and other forms of pain relief with great interest.
Earlier this year the Education and Research Committee of the Royal College of Midwives recommended that women giving birth in NHS hospitals should be charged for epidurals “unless there is a medical need for them.” The press stated that this recommendation would debated at the forthcoming conference.
No man can fully understand what the women we love have to go through to bring our children into the world. But any man who is not totally devoid of sensitivity and has heard the cries of a woman in labour can grasp that even a straightforward and quick birth with no complications is a very intense experience for the mother, and a bad one is one of the most painful and traumatic things a human being can experience.
There is a range of views about pain relief during childbirth. When my wife was preparing to give birth both she and I were astonished at how hard people at one end of the spectrum try to persuade women not to use pain relief during birth. Some of the more extreme “natural birth” enthusiasts argue against anaesthetics on the grounds that they stop people from having the whole experience of birth. Both then and now this struck me as the kind of argument you would expect from the Marquis de Sade on acid.
However, that is not the basis of the proposals from the Education and Research Committee of the Royal College of Midwives, who were raising genuine medical concerns. They based their argument for a reduction in the number of epidurals on studies which suggest that 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 evidence-based argument for encouraging wider use of alternative forms of pain relief.
It is with some trepidation that I disagree with people who know far more about this issue than I do. However, although there is a real concern, charging is absolutely not the way to address it.
As I wrote a few months ago, discouraging epidurals by charging for them would be both unjust and counterproductive. Those who could afford it would pay for anything which they perceived as reducing pain regardless of cost, and this policy might better 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, vulnerable women who are affected by poverty might be afraid to ask for pain relief even if they really need 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 of asking for help would be completely unacceptable.
Whether pain relief is provided and of what kind is not just the responsibility of the mother, it is also a matter 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 different forms of pain relief available.
Recent surveys by Mother and Baby magazine in 2002 and 2004 found that only 5% of women have a “completely natural” birth with no intervention or pain relief. Of those who responded to both surveys, 23% had a planned or emergency caesarean and 38% of women had an epidural - and neither percentage increased between the 2002 and 2004 surveys. I have seen it suggested elsewhere that the percentage of births with an epidural is about 20%.
If these surveys are correct then a very substantial proportion of mothers do ask for pain relief but go for one of the other options rather than an epidural.
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.
Comments