Delivering the facts on pain during labour

Myths and propaganda can complicate what is already a difficult personal decision

Amy, 27 years old, walks into the labour and delivery ward of a hospital; she is nine months pregnant with her first child, and started to feel contractions an hour ago. She is excited about having a baby, but scared, too — she has heard that labour is painful and that many things can go wrong.

Amy has mixed feelings about getting an epidural. Her mother-in-law advised her that the pain is endurable: “If I didn’t need an epidural, then neither do you.” Her friends from prenatal classes say “natural childbirth” is the way to go — it will make the experience more meaningful, and allow her to bond with her baby. She considers herself a feminist, but wonders whether this means she should pursue a “natural birth,” or exercise her right to get an epidural. Still undecided, she turned to internet forums, where other moms warned that an epidural could increase the risk of a C-section, or make her unable to push properly. Amy has no idea what she will do.

Ideally, the decision to get — or not get — an epidural should be made on the basis of scientific evidence and individual preference, free from outside pressures or bias. Unfortunately, as in Amy’s situation, this decision can be influenced by social and cultural factors, and clouded by factual inaccuracies.

This is not a new issue. Throughout history, pain management during labour has been the subject of conflicting opinions and perceptions, driven by diverse cultural, political, and scientific agendas.

In 1847, Scottish physician James Simpson was the first to administer chloroform to women during childbirth. It was a controversial practice from the outset; most doctors in Europe viewed pain as a healthy part of childbirth and discouraged intervention, while others objected on moral grounds. Only a few years later, however, Queen Victoria requested chloroform for the birth of her eighth child. With this implicit “royal endorsement,” the practice quickly gained widespread acceptance.

The 20th century saw new trends in obstetrics, notably “Natural Childbirth,” which emphasizes labour as a natural process and discourages intervention. The movement was founded in 1933 by British physician Grantly Dick-Read, who believed that with proper psychological preparation alone, a woman could experience a painless delivery.

Today, the epidural has supplanted other techniques of pain relief during labour, proving itself to be a safe and effective method. Nevertheless, the decision to get an epidural is a controversial one.

The Natural Childbirth movement continues to be influential, with many adherents making detailed plans for their “natural” delivery. Supermodel Gisele Bündchen has become an advocate for Natural Childbirth, delivering both her children at home despite warnings from her obstetrician that she was at risk for complications. She explained, “I wanted to be very aware and present during the birth … I didn’t want to be drugged up.”

However, this emphasis on avoiding intervention of any kind inevitably creates unrealistic expectations, and feelings of intense disappointment if things don’t go according to plan.

After actress Kate Winslet was forced to abandon natural birth for a C-section in 2000, she commented: “I was so completely traumatized by the fact that I hadn’t given birth. I felt like a complete failure.”

Not surprisingly, due to the strong opinions at play, the information available about epidurals is not consistent — and often downright false. Here are a few common misconceptions about epidurals:

1. Epidurals prolong labour.

Epidurals may prolong labour, but only by an estimated 15-30 minutes, and this does not result in any other negative outcomes.

2. Epidurals make it more difficult to push.

Modern epidurals are administered at lower doses, providing pain relief without blocking muscle control.

3. Epidurals increase the risk of Caesarean section.

This is a myth. There is no difference in the rate of C-section between women who get epidurals and those who opt for other methods of pain control.

4. Epidurals cause paralysis.

This is a common fear, but in reality, the chance of an epidural causing paraplegia is estimated at less than 1 in 100,000, while the likelihood of a woman dying from childbirth is approximately five in 100,000 in Canada.

For someone like Amy, these misconceptions add to the social factors already complicating her decision.

Pain control is an important aspect of labour and delivery, but also a highly personal choice, with a variety of safe options available. Ideally, women should have access to information about all these options, as well as the freedom to choose without external pressure or judgment.