Examining the choice behind refusal of obstetric anaesthesia

Abstract

Many women refuse an epidural during delivery, despite most women perceiving labour pain as the most excruciating event of their lifetime. This can be baffling to a physician involved in their care, but there are many historical and personal factors at play that must be taken into account. Use of obstetric anaesthesia began in 1847 and was met with controversy. In a time when childbirth physiology was poorly understood, physicians disagreed over the utility of labour pain and pain was even used as an indicator to guide delivery. Religious justification also perpetuated the reservations regarding obstetric anaesthesia. Despite initial overwhelming opposition to obstetric anaesthesia within the medical community, attitudes began to shift in favour of obstetric anaesthesia as a result of clinical observations and feminist advocacy. Obstetric anaesthesia has since been well-studied and routinely used, but historical misconceptions have endured and epidural refusal continues to linger in childbirth communities. Furthermore, there are some evidence-based concerns voiced by patients, including the risk of instrumental delivery and low risk for adverse events, which must be carefully addressed by physicians involved in patient care. In addition to concerns regarding safety of obstetric anaesthesia, pain is a subjective experience that may add meaning/fulfilment to childbirth for some patients. In conclusion, there are many historical and personal factors at play when it comes to refusal of obstetric anaesthesia, which must be understood by physicians to optimise patient care.