Laboring women may not have the strength to fight for pain relief, and according to the American College of Obstetricians and Gynecologists (ACOG), they shouldn't have to. The organization recently said that women in labor should receive pain relief  -- including epidural, spinal, and combined spinal epidural analgesia  -- on demand, at whatever point they ask for it. ACOG issued the statement, a reiteration of its two-year-old position, after fielding reports that many hospitals were requiring women to wait until they were dilated 4 to 5 centimeters before receiving an epidural under the assumption that administering it before this point could increase the risk of cesarean delivery.

The new statement notes that several studies linking epidurals and c-section rates are contradictory. "No one can give a blanket reassurance that there's no connection between early epidural analgesia and cesarean delivery, but for as many studies that show a relationship, there are almost an equal number that don't," says Michael Greene, M.D., director of the department of maternal-fetal medicine at Massachusetts General Hospital in Boston and a former member of ACOG's Obstetric Practice committee. Dr. Greene suggests that women discuss the issue with their doctors and make the choice that is best for them.

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