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Abstract
Background. Increasing intervention in birth continues to be a cause for concern and epidural analgesia is an ever more common intervention. A major influence on rising intervention rates is the complex relationship society has with technology. Influenced by various political and cultural narratives, there has been a tendency to view technological advance as both neutral and superior in the human quest for progress.
Aim. In this paper, the authors trace the dialectical relationship between culture and technology in order to investigate the way epidural analgesia is portrayed in the biomedical literature.
Method. A purposeful literature search was conducted, with databases including CINAHL, MEDLINE, Scopus, Google Scholar, Academic Search Premier and thesis repositories. Relevant literature was identified and analysed using the analytic framework of critical discourse analysis and drawing on critical medical anthropology and Foucault's discourse analysis.
Findings. The biomedical literature on epidural analgesia concerned itself with particular outcomes, such as increases in CS and instrumental birth rates, and yet maintained its narrative of epidural as 'safe and effective'.
Implications. By exposing the contextual nature of knowledge, another standpoint is offered from which evidence and practice can be reviewed. This critical literature review provides an alternate reading of epidural text and challenges some of the assumptions made about epidural analgesia, and the practices that stem from these beliefs.
Key words: Childbirth, epidural analgesia, technology, Foucault, critical medical anthroplogy, discourse analysis, evidence-based midwifery
Introduction
The epidural is considered a 'routine' analgesic choice for healthy women in labour, and its use is increasing in Australia and other high-income nations (Walsh, 2009; Lain et al, 2008). In Australia in 2012, 32.5% of women in labour used regional analgesia for labour (Hilder et al, 2014). While epidural analgesia has substantial analgesic properties it is also associated with increased risk of adverse outcomes. Significantly, the use of epidural analgesia during birth transfers a labouring women out of the category of 'normal' labour and increases her risk of intervention (Walsh, 2009; WHO, 1996).
This paper is a critical review of the epidural literature as it related to the doctoral research of one of the authors (EN). The research, an ethnography that examined influences on women in their decision to use epidural analgesia used critical medical anthropology as the primary theoretical...