The myth of painless childbirth (The John J. Bonica Lecture)

We are all familiar with John Bonica's magnificent contributions to the management and understanding of acute and chronic pain. But some people are not aware that John is also a world authority on obstetrical anesthesia. He developed a special interest in obstetrical problems early in his career, after his wife Emma had a near-disastrous experience with improperly administered ether anesthesia during the birth of their first child. He worked hard at acquiring skill and expertise in administering epidural analgesia, and subsequently organized the first 24-h medical anesthesia service for obstetrics in the United States. After two decades of experience, he wrote the 2-vol set Principles and Practice of Obstetric Analgesia and Anesthesia 4 which is an acknowledged modern medical classic. Every aspect of childbirth is addressed with the same thoughtfulness, insight and meticulous detail that are characteristic of John's books and papers on chronic pain. John has repeatedly argued 5,6 that labor is often extremely painful and that severe, prolonged pain can be dangerous to women with cardiovascular problems and to the fetus whose oxygen supply may be at risk during protracted, complicated deliveries. My recent work supports John's contention that most women suffer severe pain during labor.