Labor Pains

It's the part of pregnancy women least like to think about: delivering the baby. But in the last 15 years, a quiet revolution has been taking place. More women have decided that they'd rather not experience quite so much pain when they give birth. In the late 1980s, national surveys indicated that only about 20 percent of pregnant women got an epidural—a spinally-administered anesthetic that blocks pain in the lower half of the body—while in labor. That proportion has now climbed to two-thirds, recent surveys reveal.

Despite this increase in interest, many women still don't know a lot about their pain-relieving options, says Dr. William Camann, an associate professor of anesthesia at Harvard Medical School. Even if a mother-to-be attends childbirth class, chances are her instructor will stress either natural delivery (read: no drugs) or encourage epidurals. This can be a problem because the course of any one woman's labor and delivery is unpredictable. Women who plan on one route may find themselves detoured to the other.

That's why Camann has written a new book, Easy Labor (Ballantine Books, January, 2006) , to give pregnant women a comprehensive overview of all their options, not only for pain relief during delivery but for making labor more comfortable. Camann spoke to NEWSWEEK about what women need to know. Excerpts:

NEWSWEEK: What options do pregnant women have these days in terms of pain management?

Camann: There's the standard epidural, which involves hooking up a [spinal] catheter to a pump, and infusing the patient at a constant rate. Then there's the patient-controlled epidural. The infusion is hooked up to a button. When the woman pushes the button, she sets her own dose. She can tailor it to how much pain relief she needs. Research shows that when the patient has control of their pain medications, they actually tend to use less and they feel more satisfied. Not only do they get exactly what they need, but they also feel more in control. That's especially important during a woman's first birth when everything seems so foreign and scary and they don't know what's going on. Some women are afraid that they'll overdo it, but these systems are set up so that you can't overdose yourself. Then there's the combined spinal. It combines a spinal injection and an epidural injection, and both are done with the same needle. The advantage is that the woman experiences almost immediate pain relief, compared to the standard epidural that can take 10 to 20 minutes to work.

Do most women know in advance what they want out of labor, besides a healthy baby?