Taking Great Pains
Written By Tina Cassidy
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circa 1975-today: the epidural era
Mothers giving birth in the late 1970s and '80s had more options than ever. They could have a hospital birth — with or without pain-relief drugs. They could deliver in a freestanding birthing center or at home, as their grandmothers had. They could be administered to by a midwife, an obstetrician, or both. And, perhaps the biggest change of all, they could have their husbands by their side throughout the whole ordeal, a shift in hospital policy that only kicked in widely around the mid-1970s.
They could also have an epidural. Backstory: In 1898 German doctor August Bier injected cocaine into his assistant's spinal column. It numbed the fellow's lower body, but the next morning he awoke with horrible vomiting and headaches. Apparently, it took the next 80-odd years to finesse the method. By the 1970s, when epidurals were first widely used in obstetrics, the numbing agent lidocaine was dripped into a tube inserted by needle into a woman's spinal column. The hitch? The procedure numbed women to their chests, causing breathing diffculty and, sometimes, heart problems.
The method got further refined as doctors learned that the needles had to be smaller, so that less spinal fluid would leak from the dura, the thin membrane that surrounds the spinal cord and the brain. Such leaks caused the fluid level to drop, which can make the brain sag, pulling on the connective tissue. The result: throbbing head pain, an infamous side e<>ect, and the hefty price one sometimes paid for the drug's numbing comfort. But the better the epidural got, the more women wanted it. In 1975, 20 percent of American women chose to have an epidural; today that figure has risen to 70 percent, spiking as high as 90 percent in some U.S. hospitals. To offer some context, the epidural rate in Japan is still in the single digits.
But as with every phase of obstetrical history, when women have felt that one way of giving birth was the way — whether decreed by religious, medical, or cultural norms — a backlash has resulted. And so it seems certain that one day, maybe soon, we will abandon the epidural, just as we have given up on coca leaves and chloroform. The question is: What will replace it?
This Just In...
Patient-controlled epidurals, which allow women in labor to adjust the
timing and frequency of their anesthesia with the push of a button, have been around since 1988. What's newsworthy is this: Researchers have recently confirmed that women use an average of 30 percent less anesthesia with this method than with the continuous infusion method, where an anesthesiologist decides the dosage. Not too surprisingly, women may need less medication when they feel more in control of their pain.
