In my class, I was warned that an anesthesiologist might not be immediately available, or that some physicians were concerned with possible risks that may be associated with early placement of an epidural; specifically, the risks of increase in length of labor, or increased likelihood of a cesarean delivery. This concern, I was told, may lead to my having to wait hours until my cervix was sufficiently dilated to the magic number of 4 to 5 centimeters before I would be considered "ready" for an epidural. These potential glitches in my ability to receive timely relief sounded ominous to me, but the casual tone of the instructor's precautionary statements suggested that the possibility of my having to endure extreme pain for a period of time was seen as a reasonable part of any woman's birth experience.

Recent research has concluded that early placement of an epidural — or epidural on demand — does not increase the length of labor, or the likelihood of women ending up with a cesarean delivery. At Chicago's Northwestern University, Pam England tells pregnant women that birth is an "adventure." Cynthia Wong, M.D. and her colleagues studied the effects of the timing of epidurals on over 700 first-time moms in a landmark study, published in 2005 in the New England Journal of Medicine. Half of the women received narcotic pain relief injections, but not epidurals, until they were more than 4 centimeters dilated. The other half received the epidural much earlier in labor. The study concluded that there was no difference in the incidence of cesarean deliveries among the early versus later group. In fact, the women who received the earlier epidurals actually had a shorter labor — on average 90 minutes shorter — than those who were given the epidural at 4 centimeters.

Commenting on this study in an editorial published in the New England Journal of Medicine, Dr. William Camann, Director of Obstetric Anesthesia at Boston's Brigham and Women's Hospital and Associate Professor of anesthesia at Harvard Medical School, said, ". . . safe and effective pain relief. . . should not be withheld simply because an arbitrary degree of cervical dilation has not yet been achieved." Even the American College of Obstetricians and Gynecologists (ACOG) say, in an official bulletin issued in 2006, "Recent studies have shown that epidural analgesia does not increase the risks of cesarean delivery. The fear of unnecessary cesarean delivery should not influence the method of pain relief that women can choose during labor."

In spite of this, many popular childbirth professionals suggest women should "try" to labor and give birth without medication —  and that we should want to.

In her wildly popular book titled Birthing From Within, Pam England tells pregnant women that birth is an "adventure" and states that "many childbirth teachers and healthcare professionals unwittingly have misguided mothers by reinforcing the hope that pain can be avoided, and by supporting our natural childlike tendency to look outward for comfort and relief." She goes on to warn us that " . . .adopting a passive stance to dealing with pain has its consequences," and asks, "Is the reassuring option of analgesics or an epidural keeping you from plumbing the depth of your own resources?"

Not only is the book used widely by childbirth professionals throughout the country, the concept has become a phenomenon. England has courses, workshops and a gift shop on her website, where shoppers can find CDs, videos, "birth art" and other items, including tiny tee shirts for the newborn, emblazoned with the words "My Mama's a Birth Warrior."

Childbirth professionals with a nature-worshipping bias Since when did childbirth become about having transformative personal experience rather than about getting a healthy baby? against medical pain relief seem to suggest that only self- indulgent, entitled control freaks — void of spirituality, feminist enlightenment and the ability to bond with their young — would want a pain-free birth. But the wish to avoid pain is not an upper-middle-class whim. It's a basic human instinct, one that has been useful in preserving our species. Since when did childbirth become about having a transformative personal experience rather than about getting a healthy baby and not dying (or wishing you were dead) in the process?

Well, starting in the mid-1960s. At that time, women began to revolt against depersonalized maternity care characterized by the routine use of pain relief that rendered women unconscious or close to it. By rejecting these medications, women hoped to take back control of their birth experience. Birth philosophies that promoted the use of breathing and relaxation techniques,