October 15, 2004

Should access to epidurals be a "right"?

Today I found the reactions of the Belfast midwives I am currently working with a bit depressing. Although they are very keen to explore the concepts of Active Birth and half of their staff complement are in this group, I was left with a distinct feeling that many of them felt the ideas could not be implemented “with their kind of client”.

The hospital is located in the north of the city, in an area that is socioeconomically disadvantaged, withe the highest rate of teenage pregnancy and unmarried mothers in the UK. The welfare state provides well for young mothers and provides some incentive to have babies when young, and this has become a tradition in many families. I was also told that contraception can still be hard to obtain, as even though doctors may write prescriptions for the pill, many chemists will not stock them for religious reasons. Many teenage women make great mothers and I am not being critical of their decision to have babies, if this is what they want to do.

The welfare mentality can prove problematic and this was raised in another context by midwives in the group. Everyone in the UK contributes to the health care system through their taxes, and in return they expect access to all available health services throughout their life. This was the promise made in 1948 when the National Health Service was introduced - that with a universal health care service, paid for by all taxpayers, no-one would be denied health care whenever they needed it.

These days this promise has created problems of its own. Women are arriving into labour wards expecting that they can have an epidural on demand and maybe even a caesarean section if they desire. Women are not seeking full information about these options and it is convenient for the system to encourage their use as it makes for better control over births in busy hospitals. The lack of informed consent is a potential time bomb, which could also prove expensive if women decide to take action over outcomes they didn’t expect.

Here in Belfast, I think the high caesarean rate (29%) may be due, in a large part, to the high rate of epidurals and inductions. I got the strong feeling that many midwives were willing to offer epidurals because they believed that women should get what they are entitled to, and of course they have little else to offer (warm water, positions, hot packs etc). I hope to shift some of their thinking on these issues today and give them some alternatives they can try instead of just offering the menu of drugs. Few of these midwives have any experience of home births and some seemed uncomfortable with normal physiological labour. Their reactions to the noises of normal births (as shown in the film “Inner Strength”) indicated that they were personally unsettled, dismissing the messages of the film as “impossible with our women”.

It is a very conservative area, that was made clear, yet some are open to new ideas and the fact they so many are attending this program is a positive indication of interest in new ways of working. We will see how we go today.....

Posted by andrea at October 15, 2004 06:15 PM