I have heard that some women have painless labors, though I have never met one of these women personally. However, from my personal experience, childbirth was not the worst pain I ever experienced–having my wisdom teeth out was much, much worse.  Plus, after the oral surgery, all I got was some stumpy, bloody teeth.  It was much more fun to get a baby.

That said, women are often terrified of childbirth pain, and analogies abound: take your lower lip and pull it over your head; piss a pingpong ball; poop a watermelon.

So generally women want to plan for some pain relief in labor and birth.  For reasons I don’t completely understand, what this relief entails becomes a matter of controversy.

The Bible justifies pain in birthing as a punishment for Eve’s sin in the Garden of Eden.  The New International Version of the Bible translates Genesis 3: 16 as, “I will make your pains in childbearing very severe; with painful labor you will give birth to children.”  You can read the predictions of  birth agony in various translations here: http://biblehub.com/genesis/3-16.htm

As such, when chloroform, ether, and other chemical/pharmaceutical/medical forms of pain relief became available in the 1800s, there were objections to their use on religious grounds because great pain and suffering during childbirth were seen as being ordained by God.  I am not Jewish or Christian, but it seems to me there is not a marked difference in the use of pain relief among Biblical believers vs. non-believers (except perhaps on the most extreme end of the spectrum).  You can read more about the social history of anesthesia here: http://ecti.english.illinois.edu/reviews/52/vannatta-snow.html

Some people now proclaim that wanting “natural” childbirth, or childbirth without chemical, pharmaceutical, or medical forms of pain relief, is anti-woman or anti-feminist.  And certainly denying women these forms of pain management (in a process involving shared decision making and informed consent) would be a terrible thing to do.  However, forcing women to have this kind of pain management or not informing them of their other options hardly seems “pro-woman.”

There are many ways to relieve pain.  We go through pain all the time in major and minor ways–sometimes we medicate it and sometimes we don’t.  Techniques such as deep breathing, distraction, counter pressure, heat, cold, water, massage, acupressure, dim light, and myriad other things can be effective in managing all kinds of pain, including labor and birth pain.  No one should tell women that these are her only possible options for pain relief either (unless she is in a situation where that is actually true, such as a surprise birth on the bus).

However, some people discount non-chemical, pharmaceutical, or medical forms of pain relief as no pain relief at all.  For instance, a recent article in Harvard Magazine about rising cesareans rates said that one woman profiled had “written up a “birth plan” that included trying to go without pain relief.”  I really, really doubt that her goal was to go without pain relief.  Who in their right mind says, “Let me feel every bit of  pain.  Let’s heighten the pain potential–bring it on!” (the article is available here : http://harvardmagazine.com/2012/11/labor-interrupted)

As such, while birthing centers are quite clear that they do not offer chemical, pharmaceutical, or medical forms of pain relief, hospitals are not always clear that they do not offer, suggest, or support non-chemical, pharmaceutical, or medical forms of pain relief.  For instance, if you ask a hospital if they have tubs for laboring women (birthing centers sometimes call these “aquadurals”), they may say “we don’t allow water birth.”  Getting water-based pain relief in first stage labor does not mean one has to deliver in the tub (though through shared decision making and informed consent, it seems that choice should be up to the woman as well).  Some hospitals will say a woman can bring her own tub.  It’s hard to imagine a situation where it would be suggested that a woman bring her own epidural.

No one gives marathon runners a hard time for wanting to run marathons.  In fact, running a marathon is usually seen as an achievement to be lauded.  To laud a women who wants to birth without an epidural or other drugs, however, is somehow seen as demeaning to women who do want epidurals or drugs.  Is a marathon runner demeaning to non-marathon runners?  Even if the marathon runner is actually proud of having run the marathon while you get a little winded when you go up the stairs too fast?

Women are capable of making their own decisions about pain relief, but first they need to know their options.  These options then need to be available.  Having a plan for an unmedicated birth also does not mean a woman can’t change her mind–just as deciding to run a marathon does not make it mandatory to finish it.  Even in a birthing center, a woman may choose to transfer to a hospital in order to get an epidural.  This happens.  And just as the marathon runner might be disappointed not to have finished the race, there is nothing wrong with a woman feeling a little disappointed if her pain relief  or other birth plans went awry.

There is no reason to demean any woman’s informed choice about pain relief in labor and birth, nor to deny or denigrate the forms of pain relief a woman ultimately chooses.  What it is important to do is provide complete and accurate information, make a full array of choices available, and support a woman’s plans and ultimate decisions.  That is being pro-woman.