Thoughts on pain relief (reply to Michal)

Thank you for your comments on pain relief in labour. You raise many points. All of them are valid and ones that are raised on a daily basis and by most women that I encounter. I am not really sure what you are trying to say, but it would appear that you disagree with epidurals for pain relief in labour. This is a totally different analgesia that is administered to women in labour and it is a medical procedure that involves the skill of an anaesthetist. Because the drugs used in the epidural have the potential to lower the woman’s blood pressure rapidly, there is the need to administer intravenous fluids to counter the side effects of the low blood pressure. If the woman’s blood pressure falls rapidly, then the baby in utero (fetus) drops its heart rate (bradycardia). This is usually transient and recovers very quickly to normal. Incidentally, the fetus has no actual rights of its own until expelled from the womb (Jones and Jenkins 2002. The Law and the Midwife). So you could argue that the woman’s right to a pain free and stress less labour takes precedence over the fetus. Many studies and research have proven that if the women is pain free and not suffering from great surges of adrenalin that are a natural response to the pain impulses, then the fetus will be less stressed and more able to cope with the arduous and dangerous journey of labour.

On your other points re ARM, induction/augmentation etc. these are although related to labour separate points and as such need to be addressed on a different post. If you are trying to say, that ARM and augmentation are linked in some way to epidural analgesia for labour, then yes, there is strong research and evidence to prove that if a woman has an epidural for pain relief then there follows a cascade of intervention. The epidural can sometimes and I stress sometimes, slow the progress of labour hence the need for a hormone infusion of Oxytocinon. This increases the levels of adrenaline and thus a cycle of intervention takes place which can lead to an increase in the need for an instrumental or c.section for delivery. But, there is also other evidence that suggests that this would have occurred anyway and that being in severe pain and frightened by the pain could cause this cycle of intervention.

Finally, if the women you know are not being informed of the risks of pain relief or any procedures that are carried out on them whilst in hospital, then, the hospital is breaching its policy of informed consent and belongs in the ‘dark ages’ where that culture used to exist many, many years ago. I suggest that you do some research and find out just exactly how many maternity units are practising in this barbaric way – I can assure you that everywhere I have practised in the last 20 years, I have never encountered this approach to women centred care. All women have a right to the facts. Not only about pain relief but all aspects of their care whilst pregnant and beyond.

What would you suggest is the best form of pain relief for women in labour?