Epidural advocates might respond that women who have regional analgesia are almost always satisfied with their pain management, but Marmor and Kroll (2002) point out that satisfaction does not necessarily mean that women got what they originally wanted and note that the institution and medical staff largely control what options are available and what information women are given about them. It turns out, too, that pain has little to do with satisfaction. Studies find that fulfilled expectations, the amount of support from caregivers, the quality of relationship with caregivers, and their involvement in decision making override pain in determining satisfaction. This finding is robust: socioeconomic status, ethnicity, and national culture do not affect it. Regional analgesia interferes with these superseding factors. Once a woman has an epidural, caregivers tend the machinery, not her, and even that may be done at a distance via a central monitoring station. Epidurals merely serve as the anodyne that prevents women from noticing what is lacking in their care. Furthermore, we have a group that is not satisfied: women who planned to avoid an epidural and ended up having one. Epidural advocates attribute failure to achieve their goal to unrealistic expectations, but the expectation of coping with labor pain without analgesia is not unrealistic. The rate of transfer for inadequate pain relief among the 11,814 women who began labor in a freestanding birth center was a mere 2.5%.

Passage from chapter 12,  Epidurals and Combined Spinal-Epidurals: The “Cadillacs of Analgesia”