Few topics in birth culture carry as much moral weight as the epidural. In Singapore — and across much of Asia — "natural birth" has become synonymous with virtue. Choosing an epidural is often framed, explicitly or implicitly, as taking the easy way out. Some women report being shamed by family members, birth workers, or even healthcare staff for asking for pain relief.
This framing is not supported by evidence. Here's what the science actually says.
The glorification of unmedicated birth has complex roots — a mix of traditional values, natural birth movements from the 1970s West, and a cultural script that equates maternal suffering with love and dedication. In Chinese families, there can be a sense that the pain of labour is something a woman should endure. In some communities, asking for an epidural is seen as not being "strong enough."
The result is that women sometimes enter labour with birth plans that prioritise ideology over wellbeing — and then feel shame or failure when those plans don't hold up against the reality of active labour.
Let's clear the air: there is no medal for suffering. Pain relief is a legitimate medical choice, and the evidence unambiguously supports offering it.
An epidural is a regional anaesthesia technique in which a catheter is placed in the epidural space of the lower spine. A combination of local anaesthetic (commonly bupivacaine or ropivacaine) and a low-dose opioid (fentanyl) is infused continuously or on-demand. Modern epidurals use much lower doses than those of a generation ago.
In Singapore, the gold-standard technique is the Combined Spinal-Epidural (CSE): a small intrathecal (spinal) dose provides rapid pain relief within minutes, while the epidural catheter allows top-ups as labour progresses. The dose is titrated — meaning it can be adjusted for level of pain, stage of labour, or surgical need if a caesarean becomes necessary.
Patient-controlled epidural analgesia (PCEA) pumps, now widely available in Singapore hospitals, allow the mother to administer small additional doses herself within pre-set safety limits — giving her agency over her own pain management.
This was debated for decades. The definitive answer came from the Cochrane Review by Anim-Somuah et al. (2018), which analysed 40 randomised controlled trials involving over 11,000 women. The conclusion was unambiguous: epidural analgesia does not increase the risk of caesarean delivery. This finding held across multiple countries, hospital settings, and time periods.
The same Cochrane review found a modest increase in instrumental delivery (forceps or ventouse) with epidurals — likely because epidurals can reduce the urge to push and may slightly affect the rotation of the baby's head. This is a real effect but a manageable one, and it is significantly outweighed by the pain relief benefit for most women.
Epidurals provide near-complete pain relief in over 90% of cases. No other analgesic method comes close to this level of effectiveness.
Epidurals are not the only option. Here is a realistic summary of alternatives:
Birth plans are genuinely useful — as a communication document. Writing down your preferences for who is in the room, what music you want playing, how you feel about episiotomy, and what your first choice of analgesia is helps your delivery team understand your values. That's valuable.
Where birth plans become harmful is when they are treated as a script that cannot change. Labour is inherently unpredictable. Babies don't read birth plans. A woman who has staked her identity on an unmedicated birth may experience profound distress, guilt, and a sense of failure if circumstances change — and this distress can affect bonding and postnatal mental health.
💡 Recommended framing: A birth plan is a list of your preferences in the best-case scenario. It is not a contract. The goal of labour is a safe delivery and a healthy mother — not adherence to a document.
Choosing an epidural is not failure. It is not weakness. It is not taking the easy way out. It is a medically rational decision to use the most effective pain relief tool available during one of the most intense physical experiences of your life.
Equally, choosing not to have an epidural — for genuine personal reasons, not social pressure — is a perfectly valid choice. What matters is that the decision is yours, made with accurate information, free from guilt or shame in either direction.
If someone tells you that you "gave up" by having an epidural, they are wrong. You made a medical decision. That's enough.
References
Anim-Somuah M, Smyth RMD, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews. 2018;(5):CD000331.
American College of Obstetricians and Gynecologists (ACOG). Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. 2019.
Royal College of Obstetricians and Gynaecologists (RCOG). Pain Relief in Labour. Patient Information Leaflet. 2021.
KK Women's and Children's Hospital (KKH) Singapore. Epidural Analgesia in Labour — Patient Guide.