Tuesday 21 October 2014

In the debate about epidurals versus 'natural' birth, the ultimate choice must lie with mums

Sinead Moriary

Published 29/07/2014 | 02:30

Expectant mothers must not allow themselves to be bullied or intimidated into refusing an epidural.

Astudy claims that women who receive an epidural during childbirth significantly lower their risk of depression after their babies are born.

I once heard someone say that the epidural was the best invention since the wheel. It seems the majority of Irish women agree, with 70pc opting to have an epidural on the birth of their first child.

The search for pain medications in childbirth began a very long time ago. Egyptians used opium, the Greeks chewed willow bark.

In the 19th Century ether and chloroform became popular medications until it was proven that these anaesthetics were transferred to the newborn during labour and delivery.

From 1914 to the late 1960s they used scopolamine and morphine, until finally in the 1970s they introduced the epidural.

But it's not for everyone. A significant number of women still choose not to have pain relief during labour. They prefer the option of a completely natural birth.

The new research found that women who have an epidural for pain relief had a 14pc rate of depression six weeks after the delivery compared with a 35pc rate of depression for those who did not have pain relief.

The study, published in the August issue of Anaesthesia & Analgesia involved 214 women, half of whom received an epidural and half of whom had no pain relief at all.

Commenting on the research, Professor Katherine Wisner, a perinatal psychiatrist at Northwestern Medicine in Chicago, noted that there is a well-known connection between acute pain and depression.

"Maximising pain control in labour and delivery with your obstetrician and anaesthetic team might help reduce the risk of postpartum depression," she said.

It certainly does seem odd that no previous research has been done on the link between pain during childbirth and the development of post natal depression.

Dr Peter Boylan, clinical director of the National Maternity Hospital in Dublin, believes women should not suffer and should opt in when it comes to epidurals.

"The epidural is undoubtedly the most effective form of pain relief in labour, certainly for a first birth, there is no question about that. A lot of women find that it transforms what is a miserable experience into one they actually enjoy because they are not suffering the awful pain,"

Most women in Ireland clearly agree with him and I think in hindsight,many of the women who experienced lengthy, painful and traumatic natural deliveries would probably request an epidural if they could start over again.

But there is still a romantic notion of having a completely natural birth, devoid of any pain medication. This is well and good if all goes well.

However, if any problems do arise and the mother suffers acute pain, it can lead to her beginning her life as a parent feeling exhausted and depleted.

Clearly there is no way to have a completely pain-free delivery, but the pain can be managed and controlling that pain is important so that the woman can start motherhood without being completely flattened.

Up to 80pc of new mothers experience some degree of emotional distress after childbirth.

Almost every new mother I've ever visited had the blues at some point. Weepiness and anxiety are normal as long as they don't linger. If they do continue past two weeks, they could well lead to postpartum depression.

Serious postpartum depression includes symptoms of exhaustion, loss of interest in activities, headaches, stomach pain and backache.

I have several friends who suffered from postpartum depression and it was a long and dark road back to 'normality'.

One of them still cries when she remembers the lost months when she could barely get out of bed. She still feels that she never bonded properly with her child because of it.

So, if anything can help a woman avoid ending up with depression, shouldn't all women seriously consider it?

The important factor in all of this is that the woman makes the decision herself. Expectant mothers must not allow themselves to be bullied or intimidated into refusing an epidural because it's 'better' or 'more natural' to have no pain relief. Epidurals are here to help not hinder.

Though there are risks associated with the epidural, not all women will experience this.

For a woman who is finding labour distressing or is tired or worried or chooses it for other reasons, the benefits can far outweigh the risks.

Ultimately, it is up to each woman to weigh up the evidence and make the best choice for herself and her baby.

Irish Independent

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