"Did They Intend to Prevent Women from Giving Birth?" Mothers' Anger... Ministry of Health and Welfare Reconsiders

Painbuster and Painless Injection Combination Ban Announced
Expectant Mothers Protest "Setback to Birth Promotion"
Government Backtracks: "Combination Allowed, Non-Covered Service Under Review"

The government initially announced a revision of guidelines to prohibit the combined use of epidural anesthesia and local anesthetics (Painbuster) during cesarean sections, but after strong opposition from pregnant women and their families, it has decided to reconsider the matter.

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On the 11th, the Ministry of Health and Welfare stated in an explanatory document, "Regarding reports that the Ministry issued guidelines prohibiting the combined use of 'epidural anesthesia' and 'Painbuster,' we will finalize the revision of the reimbursement criteria reflecting opinions requesting respect for choice and expert opinions." The original administrative notice allowed only one of either epidural anesthesia or Painbuster, but the revised plan will permit both to be used, and Painbuster will also be considered for non-reimbursed use (fully paid by the patient).

This action follows strong backlash after the Ministry of Health and Welfare issued a partial amendment to the "Detailed Criteria and Methods for Application of Medical Benefits" for public comment on the 10th of last month. The amendment included a provision that, starting in July, except in cases where epidural anesthesia cannot be administered, the combined use of epidural anesthesia and Painbuster during cesarean delivery would be prohibited. Additionally, even when Painbuster is used as an exception, the patient's co-payment rate would increase from the current 80% to 90%. If Painbuster shifts from selective reimbursement to non-reimbursement, its price will rise significantly from 120,000?300,000 KRW to 160,000?510,000 KRW.

As a result, there was significant backlash on online communities including mom cafes. Critics expressed sentiments such as, "Is this sane when we already have a low birthrate?", "It seems like they are determined to prevent childbirth," "Are they saying mothers should feel the pain of childbirth as it is?", "Restricting mothers' choice is unacceptable," and "This does not reflect the reality of the low birthrate era."

On the same day, the Ministry cited the Korea Institute for Health and Social Affairs (KIHASA), which in November last year issued a 'non-recommendation for concurrent use' judgment regarding Painbuster, as the basis for the administrative notice. The Ministry explained, "The use of continuous local anesthetics together with other pain control methods lacks medical evidence, according to related academic societies and many experts." It also added, "Consultations were held with related academic societies such as obstetrics and anesthesiology, as well as multiple expert advisory meetings."

The continuous local anesthetic administration method, commonly called 'Painbuster' (continuous wound infusion, CWI), involves inserting a separate device into the fascia of the surgical site to continuously deliver local anesthetics to reduce pain. It was designated as a new medical technology in 2010 and was listed as a selective health insurance benefit in 2016. Cesarean sections involve incisions of at least 11 cm or more on the abdomen, and the resulting pain is among the most severe in surgical procedures. Since pain control with only narcotic analgesics known as epidural anesthesia (Patient Controlled Analgesia, PCA) is often insufficient, multi-modal pain management is globally recommended. In South Korea, Painbuster has become popular and established as an essential procedure for cesarean mothers experiencing severe and fearful pain.

Meanwhile, the global cesarean section rate, which was only 5% in the 1990s, rose to 21% as of 2018. The reasons for the increase in cesarean deliveries include ▲rising maternal age ▲increased multiple births ▲fear of labor pain. In South Korea, as of 2021, the cesarean section rate was 537.7 per 1,000 births, the second highest among OECD member countries after Turkey.