Monday, September 03, 2012

So, evil government to deny women pain relief in labour, right?

Cross posted from Liberal Democrat Voice 

“Doctors told to try and talk women out of epidurals to save NHS money” screamed yesterday’s Daily Mail headline.  I could understand women reading that and being outraged and terrified.

Fortunately, this being the Mail, the truth is not as bad as the headline implies. Rather than being a miserly, deficit-busting ministerial directive, this is expert, evidence based guidance drawn up by the Royal Colleges of Midwives and Obstetricians with the help of the National Childbirth Trust. It aims to reduce the amount of medical intervention during childbirth because that’s best for both mother and baby. Nowhere in the guidance is there any suggestion that those who need epidurals, painkilling drugs or caesareans will be denied them. A respected charity isn’t going to risk its reputation by putting its name to a mere cost cutting exercise.

It is patently obvious that a straightforward delivery you can walk away from and go home six hours later is less risky than a surgical procedure with a six-week recovery time.  All the evidence suggests that the alert, active participation of the mother in childbirth is best for a complication-free delivery. Injecting powerful narcotics, or spinal blocks which stop you moving can only interfere with that process and can make the baby very sleepy, so clearly if that can be avoided, it’s a good thing. We were told that in our NHS birthing classes in 1998. There is also nothing new about women being advised to try labour after a first caesarean.

Any announcement of pregnancy tends to lead to so-called friends feeling the need to scare you with birth horror stories. No wonder many women feel like they’ll need every analgesic known to humanity and a stiff gin to get through. As a State Registered Coward who doesn’t do pain, I was lucky to have an experienced friend to tell me that, yes, it would hurt, but it was manageable with a birth partner who knew what they were doing and a supportive midwife.

When my mother gave birth, she was expected to do what the doctor told her which generally involved lying in a bed for her entire labour. Over the last 45 years, women have been given much more choice but even when my daughter was born, I still had to hide from an over enthusiastic obstetrician who displayed indecent eagerness to hurry things up. I’ve had countless friends encounter everything from hostility to flat refusal when they have requested a home birth, despite the evidence showing that for second and subsequent babies at least, home birth is as safe as hospital so I’m glad to see that the guidance is supportive.

The Mail’s reporting is typically unbalanced. They quote a raft of senior medical people who rail against the guidance as denying choice to women. The voice in favour of natural birth is that of model Gisele Bundchen.  She talked sense, but model v medical establishment isn’t really a fair fight, especially in a paper which generally portrays models as brainless idiots. There were hundreds of medically qualified experts they could have asked. They didn’t even have a quote from the NCT.
Women can rest easy that they will not be denied the pain relief they need, and that they will be given advice from the medical profession that is based on evidence and not financial considerations.

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