The experience of labour with epidural analgesia

Problem and background: There is a lack of literature about what constitutes good midwifery care for
women who have epidural analgesia during labour. It is known that an increasing number of women
receive epidural analgesia for labour pain. We also know that while women rate the painkilling effect of
the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when
epidural analgesia is used.
Question: How do women experience being in labour with epidural analgesia, and what kind of
midwifery care do they, consequently, need?
Methods: A field study and semi-structured interviews were conducted on a phenomenological basis.
Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby.
They were interviewed the day after the birth and again 2 months later. The involved midwives were
interviewed 2–3 h after the birth.
Findings: Initiation of epidural analgesia can have considerable implications for women’s experience of
labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of
which is particularly marked by a subtle sense of worry and ambivalence.
Another important finding refers to the labouring woman’s relationship with the midwife, which
represents an essential influencing factor on the woman’ experience of labour. Within this relationship,
some rather unnoticed matters of communication and recognition appear to be of decisive significance.
Conclusion: After initiation of epidural analgesia the requirements of midwifery care seem to go beyond
how women verbalise and define their own needs. The midwife should be attentive to the labouring
woman’s type of emotional reaction to epidural analgesia and her possible intricate worries.
2014 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International