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How to restrict epidural use

Back in Ireland again for the last two days - another Active Birth workshop for the Irish Nurses Association. Once again we had a good cross section of midwives from various parts of the country.

The midwives from Donegal (right up in the north) floored everyone when they said that in their unit, which has about 1700 births each year, the epidural service is only available for one woman at a time. Women know this well in advance, so they are not surprised if they find they have missed out in labour. Because it is hard to organise, most women are about 6 cms dilated by the time it goes in, so the outcomes are quite good - the labour is well established and the birth not too far away. This news was received with incredulity - many of the other midwives in the group reported that epidurals were very much available in their units, usually demanded by the women. It was a good example of how a demand can be created, when there are anaesthetists looking for work.....

Meanwhile, there is still an almost uniform policy in Ireland that women can only have one support person with them in labour. There are moves afoot to lobby for changing this outmoded policy, but it is tortuously slow process and the people most resistant to the change are often the midwives. Restricting information to women seems to be common as well - in the National Maternity Hospital (known locally as “Holles Street”), they have abandoned doing labour ward visits. It is no longer possible to see the labour ward in advance - the first glimpse comes when you arrive in labour! Makes you wonder what it is that they don’t want women to see until it is too late...

We had a good workshop and lots of positive energy and ideas flowed. I will be back in Ireland next week, this time in Limerick.

Posted by andrea at October 07, 2005 11:49 PM