West Berkshire perineal management trial

The use of epidural bupivacaine for the relief of childbirth pain

Epidural anaesthesia is now a widely used method for pain relief in childbirth, particularly using the drug Bupivacaine. There are nevertheless differing opinions in the research literature about the advisability of its routine use. While it is clearly very effective in relieving labour pain, there are some consistent, troublesome patterns; for example, a strong association between epidural use and other interventions, such as instrumental delivery. Further, there are no clear answers from the research to date concerning the risks and benefits of epidural anaesthesia for infant and mother. Answers could be provided by randomized clinical trials, but meanwhile a conservative approach to its use is recommended for uncomplicated labours.

A review of post-episiotomy pain and its treatment

The authors review the frequency of reporting and severity of perineal pain in the post-partum period after episiotomy. The usage and efficacy of available analgesia is discussed.

The canadian family practice accoucheur

Family practice obstetrics is strongly influenced by demography and marketing. The falling birth rate is leading to a surplus of caregivers who may inappropriately apply their technical skills to a population of low-risk pregnant women. This in turn may lead to a 'cascade' of negative consequences for the normal, child-bearing public. The family practice accoucheur has a key role to play as an advocate of high quality, humanistic maternity care. Training programs must address the academic base of family practice obstetrics through direct teaching, role modelling, research, and quality assurance.

Episiotomy and third-degree tears

The relation of episiotomy to third-degree perineal tears was investigated in 21 278 singleton deliveries. The incidence of episiotomy was 28.4% (n = 6041). Third-degree tears occurred in 1.4% (85) of the deliveries with episiotomy and in 0.9% (132) of the deliveries without episiotomy (P less than 0.01). To avoid the effect of confounding factors, we analysed a sub-sample that included only vertex presentations with spontaneous occipitoanterior vaginal deliveries. After stratification for birthweight and parity, no relation between episiotomy and third-degree tear was found.