Brief historical evolution of childbirth pain relief

Bhavani Shankar Kodali MD

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Labor has been portrayed as a painful, life-threatening and fearsome event since the earliest recorded history and has held that status until the last century. When the anesthetic effects of ether and chloroform were discovered in the mid 1800's, many members of the British clergy argued that this human intervention in the miracle of birth was sin against the will of God. If God had wished labor to be painless, he would have created it so.  The first use of modern anesthetic for childbirth occurred a scant 3 months after Morton's historic demonstration of the anesthetic properties of ether at the Massachusetts General Hospital in Boston, Massachusetts.  James Young Simpson used diethyl ether to anesthetize a woman with a deformed pelvis for childbirth. Queen Victoria undaunted by the clergy chose one day to use an anesthetic during labor and the clergy's position crumpled like the great wall of 'Berlin'. The first woman anesthetized for childbirth in the United States was Fanny Longfellow, wife of the American poet Henry Wadsworth Longfellow. She wrote the following. 

" I am very sorry you all thought me so rash and naughty in trying the ether. Henry's faith gave me courage and I had heard such a thing had succeeded in abroad where the surgeons extend this great  blessing more boldly and universally than our timid doctors.... This is certainly the greatest blessing of this age." 

After initial reports of successful pain free childbirth, an era of conflict began predominantly between two groups.  One against and the other for 'adapting pain-free childbirth'. The former group believed that all manner of calamities -disease, drought, poverty, and pain - signified divine retribution inflicted as punishment for sin.  According to Scripture, childbirth pain originated when God punished Eve and her descendants for Eve's disobedience in the Garden of Eden.  They believed that it was wrong to avoid the pain of divine punishment. On the other hand, there were others believing that disease and pain are biologic processes subject to study and control by new methods of science and technology. Even the physicians were divided in this issue. The reluctance that physicians felt toward the administration of anesthesia for childbirth pain stands in stark contrast to the enthusiasm expressed by early obstetric patients. The group in favor of childbirth included two eminent scholars. One was nineteenth-century social philosopher, John Stuart Mill, who stated that the "hurtful agencies of nature" promote good only by "inciting rational creatures to rise up and struggle against them." The other scholar was James Young Simpson, who prophesied the role of public opinion in the acceptance of obstetric anesthesia, a fact not lost on his adversaries. Early in the controversy he wrote 

"Medical men may oppose for a time the superinduction of anaesthesia in parturition, but they will oppose it in vain; for certainly our patients themselves will force use of it upon the profession. The whole question is, even now, one merely of time." 

This prophecy has come to reality in the years that followed and the era of 'obstetric anesthesia' began to flourish as the ship entered clear waters from the initial turbulent seas.

A Change in public attitude in favor of obstetric anesthesia marked the culmination of a more general change in social attitudes that had been developing over several centuries.  Anesthetics were subsequently used increasingly for labor pain, and the concurrent drop in mortality and morbidity in both mother and infant were attributed, in part at least, to the absence of pain which permitted the midwife or obstetrician to work unhindered in difficult labors. The American College of Obstetric and Gynecology endorses their view on this subject as follows. "Labor results in severe pain for many women. There is no other circumstance where it is considered acceptable for a person to experience severe pain, amenable to safe intervention, while under a physician's care.Maternal request is a sufficient justification for pain relief during labor."   

Unrelenting  hard work and dedication from several researchers, physicians, pharmaceutical organizations, and professional societies in the last century have resulted in making obstetric anesthesia provide a safe alternative to pregnant women seeking pain-free childbirth in this century, and making their birthing experience a pleasurable memory to be cherished for a long time.

Bhavani Shankar Kodali MD
Further reading:

1. History of Obstetric Anesthesia. In Obstetric Anesthesia. Chestnut D.H. Mosby; 1999.

2.The Work of Sir JY Simpson.. Volume II. Editor: Simpson WG. Adam and Charles Black, 1871.

3. Mrs Longfellow. Selected Letters and Journals of Family Appleton Longfellow (1817-1861).  Editor: Wagenknecht, E. Longmans, Greens, 1956.

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