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No labouring of point on use of epidurals

A leading UK authority says more women should experience the natural pains of labour without pain-relieving medication, writes Brian Herron

The use of epidurals in Ireland during labour has roughly doubled over the past 20 years. “This development isn’t a good thing. Because of the increased risk of potential complications during childbirth, administering an epidural during labour is not only undesirable — it’s also often unnecessary.”

That is the message from Dr Denis Walsh, Associate Professor of Midwifery at the University of Nottingham, who says a more naturalistic approach to labour-pain management should be considered.

Dr Walsh garnered national media attention in the UK last year over his controversial paper ‘Epidural Culture’, which was submitted to Evidence Based Midwifery, a journal published by the Royal College of Midwives. He was in Ireland recently to speak at the Annual Scientific Meeting of the Faculty of Pain Medicine of the College of Anaesthetists.

“There’s a physiological purpose to labour pain; it’s a natural state rather than a problem. So normal labour shouldn’t need to be treated as a pathology,” said Dr Walsh.

“Administering an epidural can interfere with the body’s natural responses. During labour the body releases endorphins, which not only affect the state of consciousness, but also stimulate movement. Studies have shown that walking and increased physical activity during labour can assist in the process.” An epidural, in most cases, requires that a woman remain in bed.

Epidural anaesthesia
Dr Walsh said other considerations supported his position. Epidurals have been shown to increase the duration of labour, and cause a decrease in oxytocin. Additionally, the baby may become malpositioned to transverse or posterior.

Studies have shown a correlation between the use of epidurals and an increase in the use of forceps to aid delivery, by up to 40 per cent, and some recent research has indicated that epidural anaesthesia can lower prolactin levels in response to breastfeeding in the days following birth.

A link to an increase in Caesarean births and epidurals is often claimed, but a meta-analysis of the data concluded in 2005 that there was no evidence of this.

Nonetheless, Dr Walsh argues that women need to be presented with all the information regarding epidurals before undergoing anaesthesia. He points to a survey conducted in the UK that examined the quality of information given to women in labour by anaesthetists. “It displayed quite a range of what anaesthetists communicated to women. Some 50 per cent didn’t mention the risk of intervention with forceps. The need to communicate all the risk factors is essential.

“There’s no doubt that an epidural is a most appropriate treatment during labour. And if a woman is in severe distress, or there are complications, of course it should be administered.

“But during a normal birth, there are other ways to make the mother more comfortable,” argued Dr Walsh.

“There’s sufficient research to conclude that it’s the support given to the mother, not pain management, that’s the more significant factor in a positive experience of childbirth. Key to a positive experience is one-to-one support from a midwife.
“Ireland has a good record on this, but it’s less prevalent in the UK. One-to-one support has been shown to reduce the number of Caesareans carried out, and reduces the number of epidurals. A midwife can help in pain management both physically, for instance [with] massage, and psychologically, by offering emotional support.”

Dr Walsh suggests that access to water-immersion facilities — not necessarily for the birth, but for labour — could reduce the need for epidurals. There is evidence to show a correlation between water immersion during the first stage of labour and a reduction in the use of epidurals.

Hypno-birthing
Hypno-birthing is also promising avenue for research, according to Dr Walsh, but he was quick to note that not enough work has been done to prove its value. Most important is the need to listen to women’s advocacy groups and to give them a place at the table, he said.

“We need to listen to women and their experiences. For some women, going through the pain of childbirth is an accomplishment and an achievement. Many view the pain positively in retrospect.”

As a proponent of a ‘non-interventionist’ pain management strategy, Dr Walsh could be viewed an unusual choice for a conference organised by the College of Anaesthetists.

But this year, the focus was on pain management in women. A number of highly respected physicians and researchers gathered to speak about their work, including Dr Kenneth Cummings, Attending Staff Anaesthesiologist at the world leading Cleveland Clinic, and Prof James Eisenach, Editor-In-Chief, Anaesthesiology, USA.

Several Irish physicians who are expert in their field also presented at the meeting, including Dr Kevin McKeating, Consultant in Pain Medicine/Anaesthesia, St Vincent’s Hospital, and Prof Dominic Harmon, Consultant in Pain Medicine, Mid-Western Regional Hospital, Limerick.

Posted in Women's Health on 04 February 2010
Tags: obstetrics

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abortion, accupuncture, ACE inhibitors, acne, ADHD, alcohol, allergies, Alzheimer's, anaemia, anaethesia, anorexia, antibiotics, antidepressants, antihistamine, anxiety, appetite control, arthritis, ASCOT, aspirin, asthma, atherosclerosis, autism, autoantibodies, back pain, beta carotene, beta-blockers, bipolar disorder, birth, bleeding, blindness, blood pressure, body dysmorphic disorder, body mass, breast cancer, breast feeding, bronchitis, Caesarean section, calcium, cancer, carcinogens, carcinoma, cardiac syncope, cardiolgy, cataracts, cervical cancer, chemotherapy, child psychiatry, children, cholesterol, clinical trial, clopidogrel, Clostridium difficile, cognitive behavioural therapy, colectomy, colic, colorectal cancer, complementary and alternative therapies, contraception, COPD, coronary care, coronary stents, Crohn's, cystic fibrosis, defibrillator, dementia, depression, dermatology, diabetes management, diet, disability, DNA, Down's syndrome, eating disorders, echinacea, ECT, eczema, elderly people, endoscopy, epilepsy, erectile dysfunction, euthanasia, exercise, fat, fertility, fitness, flu pandemic, fluoxetine, folic acid, food labelling, fracture, fragile X syndrome, general surgery, genetics, gerontology, GIK infusion therapy, GORD, gout, haemodialysis, hearing, heart attack, heart disease, heart failure, heart health, hepatitis, HIV, hospital care, HPV, HRT, hyperglycaemia, hypertension, hypoglycaemia, IBD, ICU, incontinence, infant, infant mortality, infection, inflammatory bowel disease, influenza, invasive candidiasis, IQ, Irish Heart Foundation, irritable bowel syndrome, keyhole surgery, kidney disease, laser, learning difficulties, leukaemia, liver disease, lumbar disk herniation, lung cancer, lung disease, lymph nodes, macular degeneration, macular oedema, magnetic resonance imaging (MRI), malaria, malnutrition, Marfan syndrome, media, medical ethics, medical research, medication, meningitis, mental illness, metabolic syndrome, migraine, miscarriage, mortality rate, MRSA, multiple sclerosis (MS), NCHDs, nephrology, neurology, OAB, obesity, obstetrics, occupational health, ocular medicine, omega-3, opthalmology, oral cancer, organ transplantation, orthopaedics, osteoporosis, otolaryngology, ovarian cancer, paediatrics, pain management, pancreatic cancer, panic, Parkinson’s disease, patient safety, patient-physician communication, personality disorders, physiotherapy, plastic surgery, polio, practice, pre-eclampsia, pregnancy, preventative health care, probiotics, prostate cancer, psoriasis, psychiatric admission, psychiatry, psychotherapy, PTSD, public health, quality of life, radiology, radiotherapy, rectal cancer, reproductive health, research, resuscitation, rheumatoid arthritis, rheumatology, rhinitis, salt, SARS, schizophrenia, screening, seizures, self harm, sexual abuse, sexual health, sexually transmitted infections, SGA, sinusitis, skin cancer, sleep disorders, smoking, smoking ban, spinal injury, sports medicine, statins, stress, stroke, substance abuse, suicide, supplement, surgery, syncope, technology, teenagers, testosterone, thoracic surgery, thrombosis, thyroid cancer, tonsillectomy, tonsillitis, Tourette's syndrome, toxicology, travel medicine, tuberculosis, tumour angiogenesis, type 1 diabetes, type 2 diabetes, ulcer, ulcerative colitis, urinary incontinence, vaccine, vitamins, weight, WHO, women's health, World Health Assembly

«Previous article | Next article»

No labouring of point on use of epidurals

A leading UK authority says more women should experience the natural pains of labour without pain-relieving medication, writes Brian Herron

The use of epidurals in Ireland during labour has roughly doubled over the past 20 years. “This development isn’t a good thing. Because of the increased risk of potential complications during childbirth, administering an epidural during labour is not only undesirable — it’s also often unnecessary.”

That is the message from Dr Denis Walsh, Associate Professor of Midwifery at the University of Nottingham, who says a more naturalistic approach to labour-pain management should be considered.

Dr Walsh garnered national media attention in the UK last year over his controversial paper ‘Epidural Culture’, which was submitted to Evidence Based Midwifery, a journal published by the Royal College of Midwives. He was in Ireland recently to speak at the Annual Scientific Meeting of the Faculty of Pain Medicine of the College of Anaesthetists.

“There’s a physiological purpose to labour pain; it’s a natural state rather than a problem. So normal labour shouldn’t need to be treated as a pathology,” said Dr Walsh.

“Administering an epidural can interfere with the body’s natural responses. During labour the body releases endorphins, which not only affect the state of consciousness, but also stimulate movement. Studies have shown that walking and increased physical activity during labour can assist in the process.” An epidural, in most cases, requires that a woman remain in bed.

Epidural anaesthesia
Dr Walsh said other considerations supported his position. Epidurals have been shown to increase the duration of labour, and cause a decrease in oxytocin. Additionally, the baby may become malpositioned to transverse or posterior.

Studies have shown a correlation between the use of epidurals and an increase in the use of forceps to aid delivery, by up to 40 per cent, and some recent research has indicated that epidural anaesthesia can lower prolactin levels in response to breastfeeding in the days following birth.

A link to an increase in Caesarean births and epidurals is often claimed, but a meta-analysis of the data concluded in 2005 that there was no evidence of this.

Nonetheless, Dr Walsh argues that women need to be presented with all the information regarding epidurals before undergoing anaesthesia. He points to a survey conducted in the UK that examined the quality of information given to women in labour by anaesthetists. “It displayed quite a range of what anaesthetists communicated to women. Some 50 per cent didn’t mention the risk of intervention with forceps. The need to communicate all the risk factors is essential.

“There’s no doubt that an epidural is a most appropriate treatment during labour. And if a woman is in severe distress, or there are complications, of course it should be administered.

“But during a normal birth, there are other ways to make the mother more comfortable,” argued Dr Walsh.

“There’s sufficient research to conclude that it’s the support given to the mother, not pain management, that’s the more significant factor in a positive experience of childbirth. Key to a positive experience is one-to-one support from a midwife.
“Ireland has a good record on this, but it’s less prevalent in the UK. One-to-one support has been shown to reduce the number of Caesareans carried out, and reduces the number of epidurals. A midwife can help in pain management both physically, for instance [with] massage, and psychologically, by offering emotional support.”

Dr Walsh suggests that access to water-immersion facilities — not necessarily for the birth, but for labour — could reduce the need for epidurals. There is evidence to show a correlation between water immersion during the first stage of labour and a reduction in the use of epidurals.

Hypno-birthing
Hypno-birthing is also promising avenue for research, according to Dr Walsh, but he was quick to note that not enough work has been done to prove its value. Most important is the need to listen to women’s advocacy groups and to give them a place at the table, he said.

“We need to listen to women and their experiences. For some women, going through the pain of childbirth is an accomplishment and an achievement. Many view the pain positively in retrospect.”

As a proponent of a ‘non-interventionist’ pain management strategy, Dr Walsh could be viewed an unusual choice for a conference organised by the College of Anaesthetists.

But this year, the focus was on pain management in women. A number of highly respected physicians and researchers gathered to speak about their work, including Dr Kenneth Cummings, Attending Staff Anaesthesiologist at the world leading Cleveland Clinic, and Prof James Eisenach, Editor-In-Chief, Anaesthesiology, USA.

Several Irish physicians who are expert in their field also presented at the meeting, including Dr Kevin McKeating, Consultant in Pain Medicine/Anaesthesia, St Vincent’s Hospital, and Prof Dominic Harmon, Consultant in Pain Medicine, Mid-Western Regional Hospital, Limerick.

Posted in Women's Health on 04 February 2010
Tags: obstetrics