title: Documenting risk: A comparison of policy and information pamphlets for using epidural or water in labour.
abstract: BACKGROUND
  Approximately 30% of Australian women use epidural analgesia for pain relief in labour, and its use is increasing. While epidural analgesia is considered a safe option from an anaesthetic point of view, its use transfers a labouring woman out of the category of 'normal' labour and increases her risk of intervention. Judicious use of epidural may be beneficial in particular situations, but its current common use needs to be assessed more closely. This has not yet been explored in the Australian context.
  
  
  OBJECTIVE
  To examine personal, social, institutional and cultural influences on women in their decision to use epidural analgesia in labour. Examining this one event in depth illuminates other birth practices, which can also be analysed according to how they fit within prevailing cultural beliefs about birth.
  
  
  METHODS
  Ethnography, underpinned by a critical medical anthropology methodology.
  
  
  RESULTS
  These findings describe the influence of risk culture on labour ward practice; specifically, the policies and practices surrounding the use of epidural analgesia are contrasted with those on the use of water. Engaging with current risk theory, we identify the role of power in conceptualisations of risk, which are commonly perpetuated by authority rather than evidence.
  
  
  CONCLUSIONS
  As we move towards a risk-driven society, it is vital to identify both the conception and the consequences of promulgations of risk. The construction of waterbirth as a 'risky' practice had the effect of limiting midwifery practice and women's choices, despite evidence that points to the epidural as the more 'dangerous' option.
authors.affiliation: University of South Australia, School of Nursing and Midwifery, GPO Box 2471, Adelaide, South Australia 5001, Australia. Electronic address: elizabeth.newnham@unisa.edu.au.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Newnham
authors.affiliation: University of South Australia, School of Nursing and Midwifery, GPO Box 2471, Adelaide, South Australia 5001, Australia.
authors.forename: Lois V
authors.initials: LV
authors.lastname: McKellar
authors.affiliation: University of South Australia, School of Nursing and Midwifery, GPO Box 2471, Adelaide, South Australia 5001, Australia.
authors.forename: Jan I
authors.initials: JI
authors.lastname: Pincombe
mesh_terms: D015360:Analgesia, Epidural / Q000592:standards*; D016362:Analgesia, Obstetrical / Q000592:standards*; D001315:Australia; D036861:Delivery, Obstetric / Q000451:nursing; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D008880:Midwifery / Q000379:methods; D059408:Pain Management / Q000379:methods; D010174:Pamphlets; D010353:Patient Education as Topic / Q000331:legislation & jurisprudence / Q000592:standards*; D011247:Pregnancy; D014867:Water
chemical_list: D014867:Water
keywords: Childbirth; Choice; Epidural; Risk; Waterbirth