Labor Pains

Most women think they know what they want. Some come in with very rigid goals: They don't want an epidural, no matter what. I have seen women come in with the most excruciating labors-you can hear them screaming in agony-but once they go through the delivery, they say it was the most wonderful experience, and they are very satisfied that they didn't use any medication. There are other women who don't want to feel any pain whatsoever, and want an epidural to start with the first contraction. But others find out that it hurts more than they expected or labor proceeds very differently than they expected, or some other complication comes up, like an infection, and they change their mind.

What are some of the hardest cases to call?

Some women plan to get an epidural, but by the time they get to the hospital, they're literally minutes away from delivering. Some nurses and midwives will tell these women to just push through it. But others would say that's the equivalent of saying to a man, "Is it okay if we put a clamp on your testicles for the next 10 minutes?' There's no man in the world who would say they wouldn't rather have pain relief in that situation, so I don't think it makes sense to say to a woman, it's only 10 minutes. If she planned on an epidural and wants an epidural, I think she should have it. If she doesn't want one, that's fine too. Women come in wanting a certain kind of experience and I think it's important not to downplay the importance of that.

Why do so many more women today opt for an epidural? Is it because they're hearing that they're better than they used to be or are they hearing that labor hurts?

Both. Word of mouth is a powerful thing, and women are hearing that epidurals a lot better than they used to be. When I first started training in the early '80s, you got what we called a "paralytic epidural'. The medicine was so strong that you couldn't move your legs and couldn't even move from side to side. You couldn't feel anything below the abdomen, so some women had a hard time pushing. Doctors often needed to use forceps to delivery the baby, and that made for some bad experiences. In addition, women's legs could remain numb for 12 to 24 hours after the delivery. Today, the cocktail of medicines we use allows women to feel the tightening of the contractions so they assist with the pushing. These medicines provide really good pain relief but give women the ability to move their legs and even get up and walk around. The block also wears off more quickly.