Valerie Gommon Midwife’s Blog

Epidural v Natural Birth

Posted on: March 14, 2009


There has been quite a bit of debate this week about whether women should have access to an epidural in labour.

Of course in the majority of cases women do have access to an epidural in labour if this is what they choose, however many maternity units cannot GUARANTEE that a woman will get an epidural when she requests one.  This may be for several reasons.  A woman who has an epidural needs to have one to one midwifery care to ensure the safety of both the mother and her baby.  If a unit is particularly busy or poorly staffed a midwife may not be available to give this level of care (it is well documented that midwives are often caring for two or more women who are in active labour), secondly, an anaesthetist may not be immediately available.

The debate occurred because there have been several articles in the media recently regarding the National Childbirth Trust’s (NCT’s) views on women’s access to epidurals following the publication of a guidance document, “Making Normal Birth a Reality”, drawn up by the NCT with the backing of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. www.appg-maternity.org.uk/resource/Normal+Birth+Consensus+Statement+NEW+LOGO.pdf and www.nct.org.uk/press-office/press-releases/view/128

There was a very interesting debate on Woman’s Hour this week when Belinda Phipps, the Chief Executive of the National Childbirth Trust was interviewed opposite Smriti Singh.  www.bbc.co.uk/radio4/womanshour/02/2009_10_thu.shtml and

The programme highlighted that epidurals are extremely safe (and I say thank goodness for the fantastic medical care we have if it is needed), but I personally do feel that there are very good reasons for avoiding an epidural if possible.

Epidurals are not recommended until a woman is in “established” labour, that is that she is having regular, strong contractions and that her cervix is dilated (usually to 3cm).  The reason for this recommendation is that if the epidural is given earlier the labour could stop as labour may not be fully established.

By having an epidural, a woman is usually confined to bed.  She will need to have her baby continuously monitored by a cardiotocograph machine (CTG) as the epidural can affect the baby, she will also need an intravenous drip because the epidural can significantly lower her blood pressure and she may well also need a urinary catheter to keep her bladder empty.  Being confined to bed will not allow the normal active behaviour of the mother which will help the baby into the optimum position for birth, nor will she have the affect of gravity.  Epidurals occasionally allow the labour to progress more quickly, but more likely the labour will slow and an oxytocic drug (syntocinon) will be needed to increase contractions, and so the “cascade of intervention” continues.  It is also true that women are slightly more likely to need assistance from either a ventouse or forceps to deliver their baby as it is more difficult to “push” out the baby when you have an epidural.

Whilst being an advocate for my clients, and if (given this knowledge) a woman chooses an epidural I honestly believe it is my job to support her in this choice; this said, I believe that far fewer women would actually choose an epidural is they received appropriate one to one support, preferably from a known midwife during their labour.

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