History of the Epidural

“I will make your pains in childbearing very severe; with painful labor you will give birth to children” (Genesis 3:16)

Whether reading excerpts from the Bible or turning on the latest reality TV show about pregnancy, the story is still the same—the process of giving birth is excruciating. However, thanks to modern medicine, child labor is now drastically less painful. One of the greatest advances in anesthesia was arguably the epidural, and today epidurals have become widely accepted as an effective method for providing pain relief during labor and childbirth.

Though the first epidurals were performed in 1853, it was not until the mid-20th century that epidurals were used in childbirth. In the past, churchmen thought that pain relief during childbirth was blasphemy because it defied the word of God. However, this ideology began to change when Queen Victoria used chloroform to ease the pain of childbirth. Later that year, French surgeon Charles Gabriel Pravaz and Scottish physician Alexander Wood combined the hollow hypodermic needle with a metal syringe for the first time in history. 16 years after Queen Victoria used chloroform, Charles Fauvel became the first clinician to use a needle and syringe to inject cocaine as an anesthetic during a surgical procedure. Soon enough, this would also be used to ease the pain of childbirth in delivery rooms [1].

In 1941, Robery Andrew Hingson and James Southworth developed the technique of continuous caudal anesthesia using an indwelling needle. They then studied the use of continuous caudal anesthesia during childbirth, and its first use was on January 6th 1942 on a woman with rheumatic heart disease. Doctors were unsure whether the mother would survive the labor and anesthesia. Luckily, the mother and baby both survived. As medical knowledge grew, so did use and development of a suitable anesthetic for labor: the epidural.

Figure 1: Epidural anesthesia with the Loss-Of-Resistance technique

Figure 1: Epidural anesthesia with the Loss-Of-Resistance technique

What is an epidural? The anesthetic actually refers to the epidural space, which is the space inside the spinal canal but outside the dura mater of the spinal chord. The anesthetic is then injected into this space, and as a result can significantly decrease pain during labor. What is particularly interesting is the fact that developing anesthesia for child labor took close to a century, even after it was discovered that an anesthetic could alleviate pain in women during labor. This could be due to the fact that the medical field was still growing. Additionally, the role of religion and general belief that labor is meant to be painful would have also contributed to the lack of drive to provide an anesthetic for labor. However, when examining the role of the epidural in modern times, it is almost impossible to escape the fact that epidurals are now heavily relied on in the US by pregnant women, and are seen a apart of the “normal regimen” of pregnancy.

In 2008, the U.S. Standard Certificate of Live Birth published a report that documented characteristics of women giving birth and the circumstances of births in which epidural or spinal anesthesia was used to relieve the pain of labor for vaginal deliveries. Overall, they found that 61% percent of women who had given birth to one child through vaginal delivery received an epidural or spinal anesthesia; non-Hispanic white women received epidural or spinal anesthesia more often (69 percent) than other racial groups. The study found that levels of treatment with epidural or spinal anesthesia decreased as the mother increased in age. It was also interesting to note that usage of an epidural or spinal anesthesia increased with increasing maternal educational attainment. Furthermore, early initiation of prenatal care increased the likelihood of epidural or spinal anesthesia, as well as the attendance of the physician at birth [2].

The use of epidurals and anesthetics during child birth have seen a sharp increase in the United States, and now we can see a trend of “the medicalization of motherhood”. Proponents of natural childbirth say that the overuse of epidurals during labor can create “a snowball effect”, where additional medical intervention is required, such as using IVs that deliver synthetic oxytocin to speed up the labor process. Regardless of whether you identify with the philosophy of natural childbirth, the use of anesthetics during childbirth, or fall somewhere in between, it is remarkable to see how the development of the epidural has changed our modern birthing process.

Footnotes:

[1] Ainsworth, Steve. “The Birth Of The Epidural.” Midwives 17.2 (2014): 26-27. CINAHL Plus with Full Text. Web. 2 Dec. 2014.

[2] Osterman, Martin MJ. “Epidural and spinal anesthesia use during labor: 27-state reporting area” (2008). Europe Pubmed Central. Web. Dec 2. 2014.

Figure 1: Epidural. Digital image. Minimally Invasive Surgery and Interventional Techniques. Delft University of Technology, 24 Apr. 2013. Web. 8 Dec. 2014.

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