A leading UK authority on midwifery told a Sunday newspaper that more women should experience the natural pains of labour unaided by epidurals and other pain-relieving medication because not only do these procedures carry greater medical risk but they interfere with the mother’s ability to bond with her baby and deny her the opportunity to experience childbirth as a rite of passage.

According to an article in the Observer newspaper yesterday, Dr Denis Walsh, a senior midwife, published author on natural childbirth, and an associate professor in midwifery at Nottingham University, said that:

“In the west it has never been safer to have a baby, yet it appears that women have never been more frightened of the processes.”

“More women should be prepared to withstand pain,” he said, explaining that labour pain has a purpose, it is a “useful thing”, with a number of benefits, including:

“Preparing a mother for the responsibility of nurturing a newborn baby.”

He said nowadays hospital staff are too quick to offer pain relief, and argues that the ‘epidural epidemic’ should give way to yoga, hypnosis and birthing pools. Walsh criticizes the rising trend of pain free labour in a paper in Evidence Based Midwifery, a journal published by the Royal College of Midwives (RCM).

He said the number of women giving birth in the UK who have an epidural has nearly doubled from 17 per cent in 1989-1990 to 33 per cent in 2007 -2008. This was in spite of increased medical risks associated with epidurals, including a greater chance that the baby’s head will be in the wrong place, lower rates of breastfeeding, and longer first and second stages of labour, he added.

Walsh told the Sunday paper that normal childbirth was receding in the face of a rising “antipathy to childbirth pain” that has grown in the last 20 years. Doctors and medical staff are more risk averse, and the idea of patients’ rights have combined to create a situation where nearly all hospitals now offer epidurals “on demand” even though this may not be the best thing for mother and baby, he said.

Walsh supports an approach that he calls “working with pain” that he wants the NHS to adopt and move away from the idea that pain relief should be routine. Pain is a natural part of labour and such an approach would see women being offered yoga, hypnosis, massage and birthing pools as ways to work with and alleviate the pain, he said.

Walsh is of the view that there has been a shift toward viewing the pain and stress of labour as a negative thing rather than a natural process, a “rite of passage” in a woman’s transition to motherhood.

According to Walsh, there is evidence than 1 in 5 women who are given epidurals don’t need them, while recent research shows that normal labour helps a woman’s brain prepare effectively for bonding in a way that is better than caesarean or pain-free birth.

Mary Newburn of the parenting charity National Childbirth Trust, told the Observer that Walsh’s comments were timely. She said now that 93 per cent of births happen in hospital as opposed to at home has helped to fuel the “epidural culture”. She said there should be more antenatal education and birth centres run by midwives.

But Sally Russell who co-founded the Netmums website described Walsh’s comments as “absolute rubbish” and unhelpful to women who needed pain relief. She said women who for whatever reason can’t go through normal birth will feel “stigmatized” by his comments and “made to feel they have let themselves down because there’s such pressure to have a normal birth”.

A senior obstetrician and gynaecologist at Birmingham Women’s Hospital, Dr Justin Clark, agreed. He told the Observer that it was “wrong to suggest that modern women are somehow less stoical than in the past”, and that Walsh was exaggerating the risks of epidurals. He said they were almost always a necessary and good thing, for instance if the woman gets tired or there are complications.

However, the general secretary of the RCM, Cathy Warwick, said there would be fewer epidurals if the NHS did more to support mothers in labour who ask for pain relief because they are anxious at not getting the one to one support they need from a midwife.

In 2005 the RCM launched a UK-wide Campaign for Normal Birth which aims to inspire and support normal birth practice among midwives and is underpinned by the RCM philosophy that pregnancy and birth are normal physiological processes, and that there should be a positive reduction in unnecessary medicalisation.

— Evidence Based Midwifery

Sources: Observer, RCM.

Written by: Catharine Paddock, PhD