Anger at midwives' proposal to charge women for epidurals

WOMEN should be charged for having an epidural during childbirth unless there is a medical need to have one, midwives suggested yesterday.

Up to one in five women chooses to have the injection to relieve searing pain during childbirth.

However, because it numbs the lower half of the body, the procedure can lead to a greater need for interventions such as Caesarean sections or forceps deliveries that could increase the health risks to mother and child.

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The Royal College of Midwives (RCM) said charging women for the procedure, which costs 500 in a private maternity hospital, could stem the growing number of women demanding an epidural for pain relief and encourage natural births.

But groups representing mothers said women did not have enough choice or support during childbirth at present and it was "adding insult to injury" to restrict them further.

The Department of Health said there were no plans to restrict the administration of epidurals, but the RCM is to debate the issue at its annual conference later this year.

Louise Silverton, the RCM's deputy general secretary, said it was the responsibility of midwives to encourage women to have a more natural birth.

"Epidurals provide effective pain relief but, where there is no clinical indication that they are necessary, they can significantly raise the likelihood of other interventions such as instrumental deliveries or Caesarean sections occurring," she said.

"The United Kingdom already has an extremely high Caesarean rate and, as the acknowledged experts in normal pregnancy, labour and birth, we midwives need to debate ways in which we might help to bring this rate down."

Last month, a review found that women who chose an epidural were 40 per cent more likely to need an intervention.

It also found that women opting for an epidural were more likely to experience a longer second stage of labour - when the baby is pushed out of the birth canal.

Those women also faced a greater risk of being unable to move for a short time after birth and to experience low blood pressure.

Ms Silverton said: "This is a very serious issue and one that is likely to raise significant debate, but also something that needs to be debated if we are to improve the normal birth rate."

However, Mary Newburn, the head of policy research for the National Childbirth Trust (NCT), said charging was out of the question.

She said: "The NCT does not support the proposal to charge women for an epidural.

"This would be adding insult to injury, when women are often denied access to other options that would help them cope during labour.

"It is also an impossible judgment call to decide when some women need an epidural for pain relief and others don't.

"We need to build up women's confidence so that they can cope with the pain of a normal labour, rather than take away one of the choices that they have come to expect."

But Ms Newburn did agree with the RCM that women needed more support to give birth naturally and she called for research into alternatives to pain-relief drugs.

She said: "We know that one-to-one support throughout labour is really important for women, helping to reduce their fear and the need for intervention."