The nurse asked me my pain management plan shortly after I was wheeled into the room where I would give birth to my oldest daughter. I didn’t have much of an answer. My second semester in graduate school was just over, and I had barely begun to prepare for parenthood. I listened to my nurses and doctors about my birth plan. “What do you think I should do?” I asked. After guiding me through all my options, the nurse suggested that I try to have a natural birth. She advised me that if I felt the need for pain relief, I could try less invasive options, like morphine and nitrous oxide, before I considered an epidural.
I followed her advice to a T. I was miserable. The nitrous oxide didn’t dull my pain. It made me feel high. As far as I knew, the morphine did not do anything. I fell asleep almost immediately after the 19-hour wait for an epidural. It was amazing. My only regret is that I did not get one sooner.
Positive—nay, marvelous—though it was, I felt strangely self-conscious about how things turned out, in part because so many people asked about my experience. Many of those who congratulated me over the next few months wanted to know if I’d managed childbirth unmedicated. I found myself offering explanations and context for why I hadn’t: that the hormone they’d given me to kick-start labor had made the contractions worse, that it was the middle of the night and I was exhausted.
I gave up on this act. But these conversations made it clear to me why society holds labor pains in such reverence. It is up for debate and examination whether or not they should be relieved. This would be absurd under any other circumstances. I certainly didn’t consider forgoing anesthesia when I had my wisdom teeth taken out. It was also not something that I was asked about.
As long as doctors have used anesthesia for childbirth, it has been controversial. James Young Simpson, a Scottish obstetrician, began giving ether and then chloroform to laboring women in 1847. He was faced with strong opposition, even though anesthesia was widely accepted for its use in surgery. Although historians differ on the extent of religious objections to obstetrical anesthesia, there was certainly some moral undertones. “You do not Really bless a woman by removing the pains of labour,” one surgeon wrote in 1848. “Her True blessing flows from lifting up her heart to God, and asking for humility and strength to bear them.” Others could not see the use for obstetric anesthesia. The American physician Charles Meigs quipped that “pain of labor had never been great enough to prevent women from having more children.” But physicians were primarily—and rightfully—concerned about safety, worrying that the anesthetic would interfere with labor or harm the child, William Camann, the director emeritus of obstetric anesthesiology at Boston’s Brigham and Women’s Hospital and a co-author of Easy Labor: Every Woman’s Guide to Choosing Less Pain and More Joy During ChildbirthI was told by him.
Despite all of this, Simpson predicted that obstetric anesthesia would eventually become the norm, as “certainly our patients themselves will force use of it upon the profession.” Although he was right that pain management would become more commonplace, he was wrong that patients would be of one mind about it. The dominant feminist view on the practice has changed over the years. They argue that pain relief frees women from the cruelty and beauty of the natural world. Even though the disadvantages of obstetricanesthesia have diminished in the 175 years that it was first used, some women still long to experience the pain and brutality of labor.
At first, Simpson appeared to be correct: Objections notwithstanding, some women in American and British high society—Fanny Appleton Longfellow in 1847, Queen Victoria a few years later—received pain relief while in labor. The high-profile births of celebrities quelled fears and fueled support for modern anesthesia. By the early 1900s, feminists were pressuring physicians to administer “twilight sleep,” an injectable combination of morphine and scopolamine popular in Europe that kept women from remembering childbirth at all. The journalists Marguerite Tracy and Constance Leupp, who traveled to Germany to observe the method, wrote that making obstetric anesthesia accessible would “relieve one-half of humanity from its antique burden of suffering which the other half of humanity has never understood.”
Unfortunately, these early methods came with risks. Some women were left bleeding after giving birth due to the relaxation of their smooth muscles. When used in large amounts or with other drugs, some infants can be suffocated by Morphine. And even when mothers and babies survived, it’s not clear that anesthesia always improved women’s experiences at the time. In the late 19th century and well into the 20th, pain relief was often administered only after the mother’s cervix had fully dilated. “This makes no sense,” the medical historian Jacqueline Wolf, the author of Deliver me From Pain: Anesthesia in America and Birth in AmericaShe told me. “Women had been through all the hard stuff.” At times, twilight sleep did more to dull women’s inhibitions than their pain, causing them to thrash so wildly in the resulting delirium that hospitals sometimes restrained and/or blindfolded them during labor. In 1915, a prominent advocate for twilight sleeping was killed in childbirth. However, other drugs quickly became commonplace and by mid-century many women were being heavily medicated in hospital births and even unconscious during delivery. Again, Wolf suspects this had less to do with the mothers’ well-being than the fact that hospitals were inundated at the height of the Baby Boom. “What was an easy way to manage them? Drug them to the max,” Wolf said.
Heavy medicalization in the 1950s was met fiercely. Grantly Dick Read and Fernand Lamaze advocated non-medical ways to manage pain during labor. A new generation of feminists pushed for the right to give birth free from interventions, claiming that the largely male medical field had commandeered what was rightfully women’s domain. They accepted the argument made century ago by wary doctors: Obstetrical anesthesia unnecessarily hindered a transcendent experience.
The debate has cooled somewhat over the years, due to improvements in anesthetic techniques. The fact that epidurals allowed women to remain awake during labor allayed some women’s concerns about them, and they grew significantly more commonplace in the 1980s. The procedure has been improved to allow women to receive an epidural while their legs are not paralyzed. The tension between those in the natural- and medical-pain-management camps has eased as a result. Camman explained to me that in the beginning of his career, doulas would often leave after an epidural had been administered. Perhaps feeling that they were not doing their job well. Camman says that they now stay because they recognize the importance of support for anyone who is under anesthesia.
Although obstetric anesthesia has become more popular and less controversial than in the 1850s it is still a last resort for many women and completely unwelcome by a small minority. Wolf believes that refusing to accept pain relief is part of a normal response to its complicated history. “The truth is, it was very, very medically threatening for most of those years,” she said. And even today’s epidurals come with trade-offs. Low blood pressure can be caused by anesthesia, which can result in fetal distress. Women who receive an epidural usually also receive IV fluids and their blood pressure is continuously monitored. Recent research refutes the long-held concern that epidurals increase the chances of Cesarean birth. However, studies show that they can slow second stage labor and make it difficult to push. Both of these factors can increase the need of forceps to assist with delivery. Some women are understandably keen to avoid this possible “cascade of interventions,” Diane DiTomasso, an associate professor in the College of Nursing at the University of Rhode Island, told me.
Experts I spoke to believe that, even though the risks and trade-offs of anesthesia are decreasing, there will always remain women who desire to have labor without it. Donald Caton, an author and anesthesiologist, was puzzled when I spoke up about my confusion. What a Blessing That She Had Chloroform, he pointed out that humankind has long been ambivalent about pain, relentlessly seeking to rid ourselves of it while suspecting that it must “serve some purpose,” as he put it in one paper. Caton mentioned Ernest Hemingway, who once wrote to his fellow novelist F. Scott Fitzgerald that “you especially have to hurt like hell before you can write seriously.” When I wondered aloud whether Hemingway would have had his wisdom teeth removed without medication, Caton conceded that he presumes not. All kinds of suffering have meaning, but humans tend to avoid severe physical pain.
However, labor is not a common type of pain. Pain is usually a sign that something is wrong and alerts us to a danger to our health. “You touch the hot stove. It hurts. You pull your hand away,” Laura Whitburn, a senior lecturer at La Trobe University who studies labor pain, told me. It is a normal physiological process, and labor can be painful even when everything is fine. The accompanying pain seems to serve an entirely different evolutionary purpose; one theory is that it prompts the mother to stop whatever she’s doing, seek help, and ready herself for the child’s arrival. It is a productive pain, and according to Whitburn’s research, conceptualizing it that way can help women cope with it.
Many women do not experience labor in the same way as it is shown on television or movies. Various studies have investigated perceptions of labor pain, and although women broadly describe it as “intense, demanding and difficult,” the language they use to describe the pain varies wildly. One woman called it the “pain of death”; another, “the sweetest pain in the world.” For some, it seems, labor pain can take on a satisfying element, less like the sting of an open wound and more like the burn of running a marathon.
Even though I had an epidural, the first few weeks of my daughter’s life were like running a marathon after being struck by a train. It is difficult to let go of the pain and suffering that comes with early parenthood. I’ve run a few marathons so I know the appeal. Part of the joy is knowing that labor can be difficult and even painful. Simpson didn’t understand this many years back: Anesthesia is a triumph of nature, yes, but giving birth without it is just as rewarding. Childbirth is therefore a bizarre place in the human experience. It crosses a border between misery or meaning, between the kind and pain that harms a life and that that makes it worthwhile.
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