Why more women should get an epidural

Childbirth may be the most painful thing a person can experience, but we have the technology to numb the pain.

In Irish mythology, a man forces his heavily pregnant wife, Macha, to race the King of Ulster’s horses on foot. She wins, gives birth to twins at the finish line, and then curses the warriors of Ulster: for nine generations, they will be afflicted with five days of labor pains in times of war.<br>Childbirth is very painful, as Irish storytellers knew when they described this curse upon the men of Ulster two thousand years ago. For many women, it will be the single most painful experience of their lives, frequently described as ‘excruciating’ and ‘unbearable’.

Get the print magazine

Subscribe for $100 to receive six beautiful issues per year.

Subscribe

This pain can last a long time. Laboring women first experience increasingly frequent and intense muscular contractions, which open the cervix (the entrance of the womb) over a period of hours to days, before the baby is finally pushed out through their vagina, a process that leaves many with injuries ranging from minor to severe. In total, labor normally lasts somewhere between five and eighteen hours.<br>Just because that suffering is natural does not mean it is without consequence. Experiencing significant pain during labor may have enduring effects upon women; it is thought to be a risk factor for developing postnatal depression or PTSD. Women who have had traumatic births can find it more difficult to bond with their new baby and are less likely to have another child.<br>In Genesis, God tells Eve that ‘in sorrow thou shalt bring forth children’, but today the pain that many women experience in childbirth is effectively optional. Though a number of different pain relief options exist for laboring women, by far the most effective is epidural anesthesia. Epidurals safely remove much of the pain of childbirth for most women, while leaving the mother fully alert for the arrival of her baby.<br>In an epidural, a flexible tube is inserted under local anesthetic between the spinal vertebrae after the mother has begun having contractions. The analgesic, a combination of local anesthetic, opioids, and occasionally steroids that varies between hospitals, is pumped through the tube directly into the epidural space, located just outside the sac surrounding the spinal cord, where it numbs pain signals from the uterus and pelvis.<br>This relieves the entire lower body of pain within around half an hour. The analgesic is then continuously infused through the tube; with modern epidurals, a laboring mother can safely increase her dose at any time by pressing a button.<br>Epidurals have been available in some form for over a hundred years. The first successful spinal anesthesia was given in 1898 by German surgeon August Bier, who termed his method ‘cocainization of the spinal cord’, and two years later Oskar Kreis used this technique to give pain relief to six laboring women in a Swiss hospital. A technique more like the modern epidural, with medicine injected into the epidural space, was developed by Spanish military surgeon Fidel Pagés in 1921, and continuous epidural analgesia for labor was first described in 1931 by Romanian Eugen Aburel.

The modern epidural<br>When I gave birth to my first child on Christmas Day 2024, I asked for an epidural. Having it placed was uncomfortable, akin to a mild electric shock. But once it began to work, I felt supremely relaxed, napping and drinking tea through what should have been the most painful parts of labor. At one point, I felt some pain on the left side of my abdomen and, with a midwife’s help, turned onto my side, helping the drugs to reach those nerve roots and rapidly stopping the pain.<br>The epidural did not numb my lower body: I could feel the touch of my husband’s hand, contractions, and the pressure of my daughter’s head. The only missing sensation was pain. That’s because pain fibers are blocked more easily than the larger fibers that carry touch and movement. As I labored, the lack of discomfort was surreal. Perhaps because it was pain-free, I remember my daughter’s birth extremely well. I did experience one unpleasant and fairly typical side effect from the epidural: 20 minutes of shivering and itchiness shortly after it was put in place. But in comparison to what most women go through without an epidural, this seems like a very good deal.<br>Epidurals have other side effects. They can make birth take longer, by somewhere between fifteen minutes to an hour. In up to 20 percent of women, an epidural causes low blood pressure, though this is generally resolved with simple interventions like repositioning the woman onto her left side or giving her intravenous fluids. In up to 1 percent of women, an epidural can cause a severe headache when the needle is inserted slightly too far, puncturing the membrane around the spinal cord so that cerebrospinal fluid leaks out. This is treated by injecting...