- The Washington Times - Sunday, April 9, 2000

Anesthesia has been in use for more than 150 years, and debate still rages over whether it should be used to ease labor pain.

About 60 percent of American women receive some kind of pain relief during vaginal delivery. It's usually an epidural, a local anesthetic injected into the spinal area. A thin tube is inserted so medication can be given as needed.

However, many other women facing childbirth "refuse anesthesia outright because they feel pain is part of the birth experience" or for other reasons, such as religious or safety concerns or because of "problems of service availability in small towns" or rural areas, says Dr. Donald Caton, a professor of anesthesiology and obstetrics-gynecology at the University of Florida's College of Medicine.

Dr. Caton is the author of a new book, "What a Blessing She Had Chloroform," published by Yale University Press, which delves into the medical and social history of relieving labor pain.

The book title comes from a comment England's Queen Victoria made in 1859 when told that her oldest daughter had given birth.

Dr. Caton acknowledges that medicated births have "really increased a lot" in recent years. He estimates they have risen 10 percent to 20 percent in the past decade alone.

The number of women in labor who receive local anesthesia injections to numb the pelvic region rose sharply from 1981 to 1997, according to a peer-reviewed study that researchers at the University of Colorado School of Medicine presented at a medical conference last fall. The proportion seeking pain relief for childbirth tripled in large hospitals during that period, the study found.

Those findings were criticized by advocates of natural childbirth, who charged that anesthesia can cause complications in both mothers and babies and prevents mothers from fully experiencing delivery.

In an article in last month's issue of Mothering magazine, childbirth educator Penny Simkin makes a strong pitch for natural childbirth. She identifies about a half-dozen specific side-effect risks to mothers and babies from epidural drugs. In contrast, the Mayo Clinic Family Health Handbook describes epidurals as "safe" for mothers and infants.

Miss Simkin acknowledges that most obstetricians favor epidurals because the drugs give the doctors "more control in managing labor as he or she prefers."

Dr. Caton says epidurals used today in childbirth allow effective pain relief with much smaller doses of anesthetic drugs and fewer side effects than those used in the past.

"On the surface, it seems to be such a simple issue. There is pain, and we can relieve it … [but] childbirth is such a very personal thing, so you see a range of reactions," he says.

The debate over the appropriateness and feasibility of reducing labor pain has continued almost since the first modern anesthetic was introduced in 1846. Soon afterward, Dr. Caton says, some women began to push for its use in childbirth, but doctors first had to contend with safety issues.

Physicians realized the need for pain relief during surgery, but they saw childbirth as a gray area. "Childbirth was seen as a natural process, and physicians had a very difficult time trying to figure out if the pain of it was a necessary part of that process. They needed to determine whether eliminating or at least diminishing pain would in itself cause labor to stop," Dr. Caton says.

Long before they could answer those questions, some doctors experimented with anesthesia during labor. In 1847, a Scottish obstetrician, James Young Simpson, gave ether to a woman in delivery. That same year, poet Henry Wadsworth Longfellow's wife, Fanny, became the first U.S. woman to give birth with the aid of pain relief.

In a telephone interview, Dr. Caton noted that feminists during the past century have taken radically different positions on whether there should be pain during childbirth. In the early part of the 20th century, he says, suffragettes and other feminists pushed to make pain relief during labor available in this country.

For decades, he says, they pushed for a European technique called "twilight sleep." This therapy combined morphine and a drug called scopolamine, which causes memory loss. "Unfortunately, women didn't get much pain relief, the babies got depressed from the morphine, too high a dose [of the combination drug] could prove toxic, and women didn't remember the birthing experience," Dr. Caton says.

By the 1940s in this country, it was routine for women having babies to be given general anesthesia during delivery. "The mother was unconscious … this was considerably more dangerous," he says.

By the 1960s and 1970s, feminists had abandoned their crusade for labor medications and instead promoted natural childbirth. Today, Dr. Caton says, the "vehemence of the natural childbirth movement has passed," and women are more comfortable making their own choices on this issue.

The number of women turning to epidurals is growing, he says, but "at the same time there is this residual idea in the culture, as seen through literature, religion and politics, that maybe pain has meaning and has important social benefits."

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