Labor pain should not be approached as pathology. It has purpose and is the body's normal response to uterine contraction and the progress of the baby through the birth canal.
Death and permanent morbidity are rare complications that may result from elective epidural analgesia. As a noted anesthesiologist once said, when providing epidural analgesia, we must acknowledge that we are using an invasive and potentially hazardous procedure to provide a humanitarian service to healthy women undergoing a physiological process.
Because its analgesic efficacy is unparalleled and it is relatively safe, epidural should remain an option for pain relief in labor. But appropriate education on the risks of epidural analgesia, which include significant morbidity including bruising, pain, headache and even rarely paralysis and death, should be provided to all clients. Care providers should update their knowledge of the medications and techniques available to laboring women. Alternatives should also be discussed, including continuous emotional support (through the use of a midwife and/or doula), intravenous narcotic, intrathecal analgesia, paracervical block, complementary therapies such as hypnosis, acupressure or acupuncture. Direct costs of this elective procedure ($500 to $2500), as well as the indirect costs related to complications of the procedure, including prolonged hospital stays must also be considered.
From my own experience, I feel that epidurals are a necessary and excellent option for some women. I find they work best in women with prolonged labors. Most women can tolerate a labor which is progressive. But after many hours of minimal progress, when her support people are fading from exhaustion, when she is feeling as if all her work is not achieving her goal, the type of analgesia provided by the epidural allows a mother to rest and regroup. She should be counselled to expect IVs, artificial rupture of membranes, confinement to bed, oxytocin augmentation and that the use of internal or external fetal monitoring will now be necessary. Such interventions come at the price of medicalizing the experience and taking away some of her control over her experience. For some this is a small price to pay for relief of pain and they feel that they do get some control back when pain is relieved.