Should a woman’s desire for an epidural be examined during labor?

Bad conscience or bad communication of science?

Debate
This is a discussion post. Opinions in the text are the responsibility of the writer.

In Aftenposten Viten, Professor Ellen Blix and her colleagues state that women may have a worse overall birth experience with epidural pain relief due to a lower degree of coping and a less favorable hormonal profile in the blood.

Then, the publication’s authors add fuel to the fire by stating that recent research shows adverse effects on the child of epidural pain relief. The baby is said to have reduced instinctual behavior, poorer temperature regulation, and poorer sucking reflexes after birth.

Fortunately, this has not been tested in any way.

The accusations are based on a small study of American women who in 2013 received an epidural with large doses of a substance similar to morphine mixed in, which rendered a newborn somewhat tired. No follow-up was done beyond the first hour after birth and no problems were reported.

With modern low-dose epidural blends, even such an innocent effect cannot be demonstrated in the short term. The new methods allow the woman to feel more control by pressing a hand button and thus control the epidural dose herself, within safe limits. Recently, a large study from the renowned Cochrane Institute (Anim-Somuah, 2018) concluded that epidurals provide less pain at birth and have no long-term effects on the baby.

Blix and his colleagues believe that the use of an epidural is too extensive, at least in the Oslo area. The question then is: Who, other than the woman herself, should decide this?

We can assure you that there will definitely be no “sale” of epidurals to healthy mothers in hospitals that we know of, including Norway’s largest maternity ward at the Oslo University Hospital. The starting point is always a medical evaluation by the midwife and the doctor about the possible benefits versus alternative solutions.

A trained midwife, who has time to be with the woman all the time, is important in this decision-making process. Then the woman decides for herself and the midwife asks the anesthetist to come out. This happens regardless of the time of day and among other tasks.

Should the woman’s desire be examined? In whose case and with what criteria?

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