Doctors question low uptake of epidural in Malta

One in four women giving birth in Malta in 2019 (26%) received an epidural injection for pain relief, a Malta Medical Journal study on obstetric logbooks reveals.

The uptake of this effective pain relief method was considerably lower than rates reported in other countries – 31% in United Kingdom, 37.2% in France and 65.1-73.1% in the United States.

The study was based on data from the obstetric anaesthesia logbook, a record in which anaesthetists lists all interventions carried out over 24 hours.

An epidural is the most common form of pain relief given in labour and birth. It consists of a nerve block delivered through a small, flexible catheter that goes near the spine at the small of the back, and continues to deliver medication throughout labour.

The choice of whether to get an epidural in place of other anaesthesia or no anaesthesia at all is usually up to the pregnant mother.

The study notes Malta’s comparatively low rate of epidural uptake and recommends an investigation of “women’s perception of epidural analgesia in Malta”, especially to see “if there are any perceived barriers to access timely and safe epidural analgesia.”

According to the study, 2,350 of the 4,040 deliveries in 2019 required an anaesthetic intervention – 52% of all deliveries in that particular year. These included 1,194 lower segment Caesarean sections (LSCS). 91.4% of all LSCSs were done under a regional anaesthetic, by administering a spinal anaesthetic or topping up an epidural, a rate which compares well to the Royal College of Anaesthetists and Obstetric Anaesthesia Association (OAA) standard.

The C-section rate in Malta for 2019 – 29.6% – was comparable to the average 30.7% observed in southern Europe.

The study was authored by Glenn Abela, Benjamin Thornton, Petramay Attard Cortis and Paul Calleja from the Department of Anaesthesia and Intensive Care.

It confirmed “the wide and considerable role anaesthetics has in maternal services provided at Mater Dei Hospital” and called for the continued allocation of personnel, technical resources and regular training and audit programmes for the health professionals involved.