Labour pains

Once upon a time, there was no such thing as pain relief in labour. It didn't matter if your labour lasted an hour or three days: there was nothing to offer for the pain. As well as this, if your baby got stuck, it died and most of the time, so did you. This used to be considered part of the curse of womanhood - to punish Eve for her fall, God stated that women must bear their children in blood and pain. In our time, it is difficult to understand how absolute the word of the Bible was historically. Childbirth was a pain women had to bear.

Times have changed and obstetric practice has gone through various fashions. For example, twilight birth was first offered as a treatment for pain of childbirth in the 1860s, via chloroform (praised magnificently by Queen Victoria, who didn't have easy births despite her grand multiparity), and evolved to being normal practice in the US until the 1940s. Women were injected with a morphine based mixture in the early phases of labour, and then remained barely conscious and unaware of pain until after the birth. The side effect was a drowsy baby with decreased respiratory function.
In the 1970s, pethidine was given to labouring women in hospital, usually without consent. Our notion of informed consent is surprisingly modern - until the mid 1980s, women were shaved and subjected to enemas in early labour, monitored and confined to bed throughout the labour and then given an episiotomy during the birth without much explanation, as a matter of course, to keep things tidy and easy for the delivering doctor.
Radical midwifery began the change in obstetric practice in the 1980s, as a response to this overmedicalisation of childbirth. The radical midwifery movement saw childbirth as a natural and normal act, whereas the medical fraternity of the time saw it as fraught with risk.
Nowadays, obstetrics falls somewhere between the two extremes. Women are considered low risk, unless they fit one of a number of criteria which escalates them to high risk. Women now have a right to choose where to deliver their child, and have a choice of pain relieving medications. Some women are able to have a vaginal delivery, with minimal interference, at home or hospital. Other women have more technical deliveries, overseen by several clinicians. However, the assessment of who needs what kind of birth is done on a case by case basis, and the woman's needs are acknowledged in the process - or at least, they should be. As I've alluded to before, this isn't yet internalised procedure for all clinicians.

The issue of pain relief in childbirth is one that comes up, most often when women are in their first pregnancy and their midwife, family and friends ask them what they are planning to use. Midwives generally advise women not to plan their pain control too much, as it doesn't allow for adaptation in labour. Friends who have already had children, will often fall into one of two camps based on their experience - 'have ALL the pain relief because it's the worst pain ever and you'll DIE' or 'pain relief is for wusses'.
The red camp are scaremongerers, the blue camp are not being realistic. Nobody knows what they are capable of withstanding physically until they do it. No woman can predict how the length or intensity of their labour, whether it's their first child or ninth. There are women who have their children with no pain relief at all, and ones who have an epidural at 4cm because the pain is so vicious. Neither are wrong, or right, they're just doing what they need to do to get through it.
There are side effects of using pain relief - pethidine, diamorphine and meptid can lead to a dopey baby, or worse a baby in respiratory distress. Having an epidural contributes to birth interventions, because the woman cannot coordinate her physical pushing with the uterine contractions, and being confined to bed protracts labour as gravity cannot work. Gas and air is the safest form of pain relief, though it can lose it's effectiveness in the later stages of labour.
However, an excessively painful labour may lead to psychological problems postnatally. I had no pain relief in my first labour because it progressed so quickly that there wasn't time. For some time afterwards, I had vivid flashbacks to being in agony and terrified - pain is very frightening if you don't feel in control of it. The pain, and speed of delivery, alienated me from my baby to begin with. I simply couldn't comprehend that this child had come from me. I had been expecting a long first labour, mostly in hospital. Instead, I got two hours of agony on my toilet at home, an hour of trying not to push while I got to hospital, and then an hour of pushing. I don't know if my trauma would have been lessened if I had pain relief, but I probably would have felt more in control. It has been almost four years, and I can still feel my body trying not to push if I think about the half an hour or so before I was 'allowed' to push by a midwife.
Equally, a labour without pain relief can be extremely cathartic. I had my second child without pain relief, by choice, expecting a fast labour. I got a fast labour - 1 hour 50 minutes - and felt wholly in control throughout. The pain was awful, as labour pain is, but it never felt unmanageable. His birth was healing, both to the trauma of my first birth, and the trauma of my second pregnancy.
A drug-free labour can be extremely empowering, but a planned drug-free labour that goes awry for whatever reason can lead to feelings of failure and inadequacy. Some women consider using pain relief to be cheating, or an easy way out, rather than an advantage of modern medicine. Other women consider using pain relief as a normal part of life - after all, you take medication for a headache, why not for the worst pain you'll ever bear?

Labour pain requires management. Some women can manage it on their own, through sheer force of will, through breathing techniques or hypnosis. Some women need drugs to manage the pain. Pain thresholds vary from person to person, and people's perception of pain also varies. Most women are capable of giving birth vaginally, without pain relief, but not doing so, through choice or necessity, does not make them less of a woman, or less of a mother.