Midwives' views and knowledge on epidural analgesia during labour.

Abstract

Epidural analgesia is known by many to be the most effective method of pain relief. However, its possible side effects present a debatable issue. The literature review discusses studies which investigated the effects of epidural on the mother, the fetus and the neonate and other studies regarding the midwives' attitudes towards epidural. In this study a self-administered quantitative questionnaire was given to 30 midwives working in the labour ward at Karin Grech Hospital. A 73.3% response rate was obtained. Results showed that all participants offer epidural analgesia to women under their care, some readily while others depending on the situation. Overall, participants were aware of the side-effects of epidural, indicating that a good level of care can be provided. Yet, many participants were misled about concepts which were not proved to relate to epidural analgesia by the literature retrieved. This includes the risk of Caesarean Section delivery, the effect of epidural on fetal heart during the first stage and the believed benefits from discontinuing epidural analgesia late in labour. Generally respondents did not favour late administration of epidural due to more chance of a prolonged labour. The majority also said that consent is sought from the labouring woman before epidural placement with the advantages, disadvantages and the procedure being explained. The depth of information given depends on the anaesthetist present, with the midwife giving further explanations most of the time. Overall midwives saw epidural analgesia as enhancing their practice because they are able to work in a calmer environment thus having more time for a therapeutic relationship. Those who saw epidural as hindering the midwifery practice claimed that this is so due to the growing medicalisation of birth. The study findings suggest recommendations for further studies and potential practical implications. The development of short courses or lectures delivered by competent professionals to midwives would help in providing more evidence-based care and enhance knowledge.