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Anxiety rises over ban on combined use of anesthetic drugs during childbirth

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Health ministry's scheme criticized for limiting woman's right to choose
By Jun Ji-hye

Soon-to-be mothers are expressing confusion and fear over the health ministry's delayed review of a ban on the simultaneous use of epidurals and continuous infusion of local anesthetic, widely referred to as painbusters, during childbirth through cesarean section.

Their anxiety is intensifying as the ban is about to take effect next week unless the ministry announces a decision to amend it.

Earlier this month, the ministry said it would reconsider the ban, announced last month, after facing a huge backlash from pregnant women who criticized the government for restricting women's right to choose.

Online communities have already been filled with inquiries posted by pregnant women whose due dates are approaching.

"My due date is July 11, and my C-section date is set for July 4. My doctor told me to choose either epidural anesthesia or painbuster, citing there are no new guidelines from the ministry yet," a woman wrote on a Naver cafe with over 3 million members.

"I am very afraid when thinking that I will lose one option for pain control."

An epidural is a numbing medicine given by inserting a needle and a catheter into the lower part of a woman's back. A painbuster is a continuous infusion of a local anesthetic into tissue surrounding the surgical incision via a catheter placed during surgery prior to wound closure.

These two methods have been widely used together for pain relief during C-sections. In this case, the national health insurance covers 70 percent of the epidural and 20 percent of the painbuster.

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Controversy began after the Ministry of Health and Welfare said last month that it would impose the ban on the simultaneous use of the two, except in cases when a patient cannot have an epidural.

If a painbuster is used alone, the national health insurance coverage would be reduced from the current 20 percent to 10 percent, which means a patient should bear the remaining 90 percent, the ministry said at the time.

It said the decision had been made based on a report by the National Evidence-based Healthcare Collaborating Agency, which stated that there is no significant difference in terms of pain relief between when an epidural is used alone and when it is used together with a painbuster. The report also said a painbuster is not recommended as it contains much more anesthesia than the epidural.

The decision, however, provoked immediate criticisms from women for limiting mothers' choices for anesthetic procedures. In particular, critics questioned the appropriateness of this policy at a time when the country is fighting low birthrate challenges. They said women's hesitation to give birth will only worsen if such a policy is implemented.

"Effectiveness of medications differs between people, and women need all possible options when giving birth because of the unimaginable pain," said a 35-year-old Jungnang District resident, who has a 2-year-old son.

"It seems very irrational that the government limits pain control options, considering that it is women, not policymakers, who give birth."

Politicians joined the criticism. Jeon Eun-soo, a Supreme Council member of the main opposition Democratic Party of Korea, said on June 12, "These days, one in two pregnant women opt for giving birth through C-section. The government's abrupt policy change is raising fears and anxiety of these women who have made a difficult decision to give birth in this low-birth era."

Growing criticism has led the ministry to move to reassess the policy. On June 11, it said, "We will listen to more opinions of pregnant women, doctors and experts before finalizing the scheme."

But with less than a week left until the ban is to begin, the ministry has yet to announce the finalized version.

Some local media reported that the ministry may allow the simultaneous use of epidurals and painbusters but completely remove the national health insurance coverage for the latter.

Amid mounting speculation and confusion, a ministry official said, "The issue is still under review."

Jun Ji-hye jjh@koreatimes.co.kr


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