The Role of Social, Economic, and Religious Factors in the Availability of Neuraxial Labor Analgesia Worldwide

The suffering of labor pain has been described for millennia. The first widely publicized use of labor analgesia was reported in medical journals in 1853, when Queen Victoria received chloroform as analgesia for her seventh labor and vaginal delivery at Buckingham Palace. In the 1930s, caudal techniques in the United States provided labor analgesia to thousands of laboring women, and favorable results were described in the Journal of American Medical Association. Presently, epidural labor analgesia is a mature technique, as appropriate doses, tools and protocols have been developed to minimize risk and optimize benefits to the patient and her fetus. However, the great majority of women, both in developed and less developed nations, are not offered this efficacious and safe labor analgesia choice. Recent literature has shown that epidural rates in labor are very high once the technique is available and laboring women are presented with the free choice to adopt it. It is important to develop a future strategy to offer labor epidural analgesia to a much larger group of women globally.