Grimace and bear it, say men

Sam Crawshay had an epidural with the birth of Molly (left), and baby Lily. Photo / Getty Images

Epidural rates among Auckland women are more than twice the national average, prompting concern from the National College of Midwives.

Figures collated by the Herald on Sunday show almost 60 per cent of the 7589 women who gave birth in the Auckland District Health Board area last year had the pain-relieving injections, a similar rate to the previous four years.

New Zealand College of Midwives midwifery adviser Lesley Dixon said the national average was 28 per cent and she was "surprised" by Auckland's "extremely high statistics".

She called on the health board to investigate and said she was concerned there might be "a culture of fear" about giving birth there.

Auckland City Hospital clinical leader of women's health Denys Court agreed the figures were "of concern" and said the subject would be discussed at a conference at the hospital in August.

But he argued the rate was probably comparable with other big centres overseas and suggested several possible reasons, including:

Epidurals are more readily available in Auckland than some other centres.

Auckland women choose to have them because they know more about them from "over the teacups" discussions.

Auckland has a high proportion of first-time mothers who tend to have longer labours.

Auckland has New Zealand's largest maternal foetal medicine unit which deals with high-risk pregnancies, including caring for babies born under 32 weeks from Auckland and Northland and some other parts of the country.

The injections are back in the headlines after a British academic criticised the UK's epidural epidemic.

The number of births involving them soared from 17 per cent in 1990 to 33 per cent last year.

Dr Denis Walsh, a male associate professor in midwifery at Nottingham University, said women should endure the pain of labour without anaesthetic drugs.

He said it was a "rite of passage" which helped regulate childbirth and made it easier for mothers to bond with their babies. Walsh said pain during childbirth was a "purposeful, useful thing" which "prepared mothers for the demands of motherhood".

He encouraged other pain relief options like yoga, birthing pools and massage.

Dixon said she didn't think there was an epidural epidemic in New Zealand, but agreed they should be used less often in uncomplicated pregnancies.

The council's view is that pain is a normal physiological response to childbirth and more women with straightforward deliveries should be guided through the pain by skilled midwives.

Court said epidurals were safe and had no effect on the baby, unless the mother's blood pressure dropped dramatically.

That could reduce the flow of blood to the placenta and affect the baby's oxygen supply.

But that was rare and the situation could be corrected rapidly without significant impact on the baby.

AUT head of midwifery Jackie Gunn said she understood Walsh's position and some women found a drug-free birth "empowering".

But others could not cope with the pain or needed epidurals when complications arose.

She said areas like Manukau could have a lower epidural rate because of large Maori and Pacific populations.

They tended to have large families and be more knowledgeable and less fearful about births.

European and Asian women tended to have smaller families and less experience so were more fearful.

Gunn said no woman should be denied an epidural if they want one because pain tolerance was "individual".

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Life, death and the wonder that is the spinal epidural

Nurse and mother of two Sam Crawshay says if women can give birth without an epidural "that's wonderful", but if not, "they shouldn't feel guilty".

The 32-year-old had an epidural during the birth of both daughters, Molly, 3, and Lily, four months, at Wellington Hospital.

She had planned to avoid pain relief, but that changed when she was two weeks overdue with Molly and had to be induced.

After five hours of "unbelievable pain" and vomiting she requested the injection.

"I didn't want one but thank God it was there for me. I don't think I could've gone through it without one."

While pregnant with Lily, Crawshay wanted a home birth and no pain relief. But at 36 weeks she bled and had an emergency Caesarean section, which required an epidural.

"If Lily had been born 100 years ago both her and I would have died, I could have bled to death," she said.

Crawshay said having epidurals did not stop her from bonding with her girls.

She understands UK associate professor in midwifery Denis Walsh's call for fewer epidurals but said women should not feel bad if they have one.

"You just can't say something like that when you have no chance of ever experiencing it ... giving birth can be unbelievably painful."