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Epidural use in NSW

Browsing amongst the statistics in the NSW Mothers and Babies 2003 report makes rather sad reading. It seems that women today are opting for epidurals more and more and that the use of drugs for labour is still very high. Very few babies will be born with no exposure to drugs and I wonder what impact this might have on their future health.

There is the usual variation in rates for drug use amongst city and rural areas, district and teaching hospitals, smaller units and larger ones, private and public hospitals. The best results are in the country areas, where Queanbeyan enabled 28.1% of women to labour without drugs and Muswellbrook achieved a 26.7% drug free labour rate. In this report, smaller units with fewer than 200 births per year are grouped in each region, and in the North Coast Region, (this takes in the trendy areas of Coffs Harbour, Bellingen, Byron Bay, Mullumbimby) the smaller hospitals achieved the most outstanding result : 34.6% of women giving birth in these hospitals used no drugs during labour. These hospitals will have few facilities for epidurals, often only GP care (no obstetrician), the midwives are known to the women (small country towns) and often have very experienced staff - they are therefore often better placed to practice midwifery, rather than obstetric care.

The city hospitals do predictably worse. The private hospitals are incredible: only 2.3% of women at the Mater Private, 3.0% at Sydney Southwest Private, 2.7% at North Shore Private and 3.3% at the Sydney Adventist Hospital gave birth without drugs for pain. Perhaps this is the “too posh to push” brigade or just the results of clever selling of epidurals to vulnerable women with money in their pockets. It makes you wonder, when 4.3% of the women in Fairfield, 7.3% of women giving birth in Bankstown and 7.1% of women at Hawkesbury Hospital need an epidural, compared to the affluent areas of the city, where 64.5% of women at Kareena Hospital, 60.5% at the Mater Private and 64.8% at Hurstville Community can’t manage labour without one.

A woman came into our office the other day to buy an EPI-NO. She wanted to avoid stiches and was prepared to use this device to reduce the risk of needing an episiotomy. I spoke briefly to her and gave her some hints for keeping an intact perineum: staying upright, not pushing too much, taking time etc. She explained that she had already booked her epidural (she is going to the regular labour ward of a bit city teaching hospital) and that upright birth might be difficult. I pointed out that she had a 50% chance of either forceps or vacuum with an epidural (and forceps will require an episiotomy) and she said she knew this. It was her obstetrician who had recommended the EPI- NO and I was surprised, because with an epidural (which I’ll bet he didn’t discourage) he would know that she was more likely to end up with intervention. He is having her on, I thought?

No wonder epidural rates are so high - women give up even before they give themselves a chance. Do they realise what they are taking on with these levels of interference in labour? Have they given any thought to the risks an epidural, or other drugs, poses for their babies? This is information that is usually lacking in prenatal classes and the women I saw last week said her classes were “pretty useless” (her words). I know that at that hospital, the talk on epidurals is given by the anaesthetists.... !

Posted by andrea at January 31, 2005 06:44 AM