Mar. 1, 2000 GAINESVILLE, Fla.---Is the pain of childbirth an ancient curse, a meaningful passage to the beginning of a new life or simply a bout of agony to be endured with a generous helping of anesthesia?
Views of labor pain have shifted with the times, shaped by culture, but also by advances in medicine. Physicians have found reasonably effective ways of diminishing the most excruciating sensations, yet the 150-year history of anesthesia reveals what a complicated journey it has been, according to a University of Florida anesthesiologist.
"On the surface, it seems to be such a simple issue-there is pain and we can relieve it. Yet there are many philosophical and social ramifications, which have been viewed in very different ways through the years," said Dr. Donald Caton whose recently published book, "What A Blessing She Had Chloroform," delves into the medical and social history of relieving labor pain.
"Childbirth is such a very personal thing, so you see a range of reactions," Caton said. "Today, some women refuse anesthesia outright because they feel pain is part of the birth experience. Some refuse it for biblical reasons, citing the Book of Genesis story and its linking of punishment with childbirth."
And under the banner of feminism, women have alternated between demanding that anesthesia be given or insisting that it not.
The diversity of attitudes has at times caught the medical field off-guard. Caton, a professor of anesthesiology at UF's College of Medicine, says that early in his career he was surprised when some women would refuse his assistance. Now he sees obstetric pain relief as a fascinating case study of how science and culture evolve, influencing each other along the way.
Soon after the first modern anesthetic was introduced in 1846, some women began to push for its use in labor. Physicians, however, had to grapple with issues of safety -- and at a time when they were only beginning to learn how to investigate such questions scientifically.
"In 1820, they still had been learning that the body is composed of earth, air, fire and water and that disease is caused by an imbalance of those elements," Caton said. "So when anesthesia became available, physicians had a lot to sort through. It was first used for surgery, which makes sense because without pain relief, some operations simply couldn't be performed.
"But 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."
Though it would take into well into the next century to answer those questions, that didn't keep physicians from experimenting. In 1847, Scottish obstetrician James Young Simpson administered ether to a woman in delivery, just a few weeks after a Massachusetts dentist had publicly demonstrated its use for surgery. That same year, Fanny Wadsworth Longfellow, wife of the poet, became the first woman in the United States to give birth with the aid of pain relief.
In England, Queen Victoria was an early recipient. Then in 1859, when her oldest daughter gave birth, the queen offered the phrase that would become the title of Caton's book: "What a blessing she had chloroform."
But while physicians continued to study the effects of labor medications, obstetric anesthesia was far from routine. By the early 20th century, American feminists had become more and more impatient that labor pain relief was not widely available.
They campaigned for a new European technique called Twilight Sleep. Unfortunately, the combination of morphine and a disorienting drug called scopolamine was far from the perfect solution. Pain was still significant, and too high a dose could prove toxic. What little Twilight Sleep had to offer was of dubious value: the possibility that women would forget the birthing experience.
As the 20th century wore on, though, anesthesiologists became adept at relieving pain in a manner they believed to be safe for both mother and child. However, their confidence in its safety led to higher and higher doses, which sparked a backlash. English obstetrician Grantly Dick Read advocated a return to natural childbirth, and later French obstetrician Fernand Lamaze did as well. A new wave of feminism in 1960s and 1970s took up the cause against medicalized childbirth, arguing that physicians were taking away women's right to experience labor and delivery.
Today, Caton believes, the vehemence of the natural childbirth movement has passed. Women appear to have less pressure on them to choose or reject anesthesia. Currently, about 60 percent of women in the United States receive some form of pain relief for vaginal delivery, usually an epidural, a type of regional anesthesia.
"At the same time," Caton points out, "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," such as establishing family bonds, inspiring people to try harder or as a method of controlling criminals.
"In childbirth, you continue to see that for some women, experiencing childbirth pain is extremely important to their personal and social development," Caton said. "But then there are a lot of people who think, 'I have local anesthesia when I go to the dentist's office, I'm certainly going to have it when I have my child.' So most of them do."
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