Thanks Linda.
I was trying to avoid getting into a 'value' debate about different types of analgesia (e.g. pethidine is less desirable than TENS), but there is an inherent notion of judgement if we compare analgesia. Anecdotally, some midwives pride themselves on 'getting women through labour' using less pharmacological analgesia, and I would have thought a key feature of 'natural birth' is to achieve birth without recourse to drugs.
I suppose the distinction is really between using pharmacological and non-pharmacological methods. Nobody criticises the use of a warm bath as a pain-relieving method in labour, but there are plenty of critics of opiate or epidural analgesia.
It may be that the best way forward is simply to compare the incidence of pharmacological and non-pharmacological methods * which then begs the question, where does Entonox fit in?
Andrew

Dr. Andrew Symon
Senior Lecturer
School of Nursing & Midwifery
University of Dundee


>>> [log in to unmask] 20/09/2005 07:05 >>>
Good morning all!
This is an interesting question, Andrew. Have I understood correctly, that
you are considering the use of values for different types of analgesia? Are
these values in some way a measure of  "good" or "less good" ?
If I've got that right, then my next question would be; from who's
perspective might analgesic methods be "good" or "less good" ? Would we
weigh mothers', babies' and scientists perspectives?
If we take it from the purely evidence-based perspective, we have of a deal
of research showing negative effects of some of the major types of
analgesia, but is the evidence sound? Do we really know enough about the
effects of different analgesics on mothers or on babies and do we know
enough about the effects of no analgesia on mothers or babies to be able to
grade types of analgesia?
We shouldn't underestimate the authority which the public allows our
profession. What we do or say as a profession has the capacity to effect the
beliefs of the childbearing population, so we should be cautious about
ratings if we don't have the evidence. 
There's probably a lot to say about the mothers' and babies' perspectives
but I'll leave that to someone else.
I will follow this with interest!
Best wishes,
Linda Kvist
Sweden.
__________________________________
Linda J. Kvist
Care development manager, Helsingborgs Hospital.
doctoral student, Karlstads University, Sweden.