[Economic and social problems posed by peridural anesthesia and obstetrical analgesia].

It is impossible not to note the small number of epidural anaesthetics given for obstetrics in France. The rarity of centres where it is offered by a team of specially trained anaesthetists and obstetricians contrasts with the increase in demand from the patients themselves. Study of the number of epidural anaesthetics predictable in obstetrics according to the criteria of indication indicates that the procedure could be used in as many as 30 to 50 per cent of deliveries. This implies a need for an increase in the number of anaesthetists, i.e. an increase not so much in the total number as in those trained in obstetrics with experience of epidural anaesthesia. Similar changes are necessary in hospital organisation, in such a way that the place of the anaesthetist in the maternity unit is recognised officially, this recognition being strengthened by routine out-patient consultation with all patients during their pregnancy. The economic aspect of a possible increase in the number of epidural anaesthetics carried out in France and in the number of anaesthetists performing the procedure is envisaged in terms of salaries in the public hospital system, costing of the procedure by the Social Security and the true cost of epidural anaesthesia.