Regional analgesia in labour permits childbirth without fear

EDITOR—Several points in Johanson et al's review on the medicalisation of childbirth deserve comment.1 Firstly, maternal mortality related to anaesthesia has declined dramatically over the past few decades. Recent surveys from both the United Kingdom and the United States find that the few fatal complications of anaesthesia in obstetrics are usually related to complications of general anaesthesia—for example, loss of airway or hypoxia. 2 3

The decline in the use of general anaesthesia for caesarean delivery must partly be attributed to the rise in use of regional analgesia during labour.4 In fact, the American College of Obstetricians and Gynecologists has issued a statement saying: “Failed intubation and pulmonary aspiration of gastric contents continue to be leading causes of maternal morbidity and mortality from anesthesia. The risk of these complications can be reduced by careful antepartum assessment to identify patients at risk, greater use of regional anesthesia when possible, and appropriate selection and preparation of patients who require general anesthesia for delivery.”5

Johanson et al's paper states that women are “encouraged” to receive epidural analgesia in labour. This paternalistic attitude ignores the fact that most women in labour choose epidural analgesia of their …