After Queen Victoria of England used chloroform while she was in labor with her eighth child, she and her physician were widely criticized by the medical establishment. One doctor wrote that "it was the act of a coward to avoid pain, and if a woman insisted on the use of chloroform to alleviate her labour pains, she must be told that she was in no fit state to make decisions." Churches also spoke out, saying anesthesia was against God's will, particularly in the context of childbirth.

The Queen's reaction? She used chloroform again for the delivery of her ninth and final child, starting a trend that is still controversial but certainly much more refined than it was back in 1853. Women are still criticized and often feel guilty for requesting pain medication in labor, but a new study shows that guilt and the idea that a woman should just "take it" may be causing more problems than it's preventing.

The main point of Dr. Cynthia Wong's study, published in the New England Journal of Medicine, was to show that women receiving epidurals earlier in labor did not have a higher incidence of Cesarean section deliveries than women who received epidurals later in labor. Typically, an epidural is given when the woman's cervix is at least 4 to 5 centimeters dilated. Prior to that, pain relief – if given at all – is usually provided by narcotics given by injection or intravenously.

Previous studies have indicated that women who have early epidurals also have an increased risk of C-section births. However, Dr. Wong, an associate professor of anesthesiology at Northwestern University Feinberg School of Medicine in Chicago, suspected that these studies were making assumptions based on faulty reasoning. She likened it to looking outside on a rainy day, seeing a lot of umbrellas and coming to the conclusion that umbrellas cause rain.

"If you look at all comers in any institution, women who have epidurals have a higher C-section rate, but that doesn't mean epidurals cause C-sections," says Dr. Wong. "Rather, the request for pain medication early in labor can be a marker for another problem that can lead to a C-section."

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