Pain Medication for Labor Is on the Rise

by Katy Abel

She's counting the days: Grace Lin's baby boy is due in just three weeks. A recent birthing class grad, she's hoping to have a natural birth. Or at least try for one. Though her delivery date is fast approaching, the subject of epidurals hasn't come up in talks with her midwife.

"I will try to avoid (pain medication)" she says. "I think that way, the moment when the baby comes will be more moving."

All Natural Births No Longer the Norm
Though tradition still holds that "natural" births are better, new research findings suggest more women are opting for pain medication during delivery. A survey of 750 hospitals nationwide reveals that the number of women in labor who had regional anesthesia (epidurals or spinal injections) tripled from 1981 to 1997 (from 22 percent to 66 percent.) The findings were presented this week at a meeting of the American Society of Anesthesiologists in Dallas.

"The techniques we have are so safe and effective that it should come down to what a woman needs to give herself the ideal birth experience," said Dr. Joy L. Hawkins, who did the research.

Some doctors, midwives and childbirth educators disagree, citing risks, however minimal, to the mother and baby.

"Years ago we would tell women 'Oh you can do it. You don't need (medication),'" recalls Andrea Browne, a labor and delivery nurse at a large urban hospital. "Part of it was that the old epidural made you really, really numb and women couldn't push or had to push for a longer time."

Smaller Doses
Now, she notes, improvements in anesthetic drugs allow for much smaller doses - and greater feeling on the part of the woman in labor.

"I felt the pushing and the cutting and the ripping," recalls Susan Feldman, who had an epidural when her son was born last spring. "I felt the contractions, everything."

But do women lose anything else besides pain when they gain relief through medication? Some women believe labor is a more empowering experience when it occurs free from medical intervention. Others disagree -- strenuously.

"I don't buy that at all," says Anne Montefiore, mother of two, who gave birth without medication due to time factors in delivery. "I wanted all the technology and help I could get. I was too focused on the baby to focus on how I was feeling about myself."

Lowering Pain Tied to Rising Costs
Beyond improvements in medications and procedures, another factor leading to increased use of epidurals is one few medical professionals are willing to discuss publicly -- the need to move women in and out of hospitals quickly, due to rising medical costs.

"There's the element of insurance companies," Browne says. "If you're not a certain number of centimeters dilated or if you don't progress quickly enough in labor, you get sent home or you get pitocin (drug to induce labor)." Pitocin drips often result in harder, faster labor, only to be followed by urgent cries for pain relief.

Reduced staffing at hospitals is also an issue: "The staffing situation makes it harder to be with a patient who isn't having an epidural, because they need you one on one," Browne says. "They need you to coach them through every contraction, and a lot of the time we're taking care of more than one patient."

Whether or not epidurals are more expedient for hospitals, they win rave reviews from the growing numbers of women who refuse to see labor as an endurance or strength test.

"I really don't believe you have to suffer to experience something fully," says Montefiore.