A critical literature review of epidural analgesia

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.