WOW. There is not enough time for me to respond to all of the statements above. But I will say a couple of things:
To chaoticzenmom: The "walking epidural" that I have been using routinely for 20 years no in my practice allows most women to move around uite a bit, and, yes, even to walk, if their obstetrician permits it. Fact is, most women prefer to rest comfortably in bed wile their uterus does the work and their cervix dilates. I have been asked to place epidurals late in labor for women who were in too much pain to push effectively. Women with "walking epidurals" can get in all kinds of positions and squat or whatever they need to do to enhance delivery.
To aleatha5: Fortunately, ethical randomized studies CAN be designed. They have been done, they are being done now, and hopefully, they will be done in the future. It's the only way we can get meaningful, reliable, data. But the unstated basis of your concern is reasonable: Since everyone knows and agrees that epidurals are without doubt the best way to releive the pain of childbirth, how can we design a study that randomizes women to a group that is denied the best pain relief?
To phathui5: The table you refer to is quite flawed. Many, many errors. But there certainly are risks to epidurals - some really bad risks. But there are risks to a lot of things in life. For example: there is a risk of driving to the hospital. So is home birth safer? Well, the most recent data shows a 2 to 3-fold greater risk of death for the baby at home compared to hospital. Everyone has to make their own INFORMED decision. What I have attempted to do in "Epidural Without Guilt" is make a point that is usually not made: That AVOIDING the epidural may very well be more risky than using the epidural.
To soso-lynn: Can we please stop speaking about the financial aspect of this? I have made it very clear that I do not benefit financially from putting in an epidural. I work in a very large department and the fee for any one particular epidural represents a miniscule percentage of our income. Obviously, if no woman wanted an epidural, it could be a different situation. But that's not going to happen. More than 70% of American women use epidurals and spinals. Others avoid them like the plague. That's their decision. An more power to them. But decisions should be based on data. Not misinformation. Not fears. Not myths. Not pressure from anyone. But really, please stop discussing the financial aspect of this. It's not the reason I enjoy placing epidurals iin laboring women. The gratification of relieving a fellow human's misery is more valuable than any financial reward. Furthermore, I know that doulas make quite a bit of money - cash in many instances - for providing care for women in labor.. But I would never impugn their motivation. I wouldn't say: "Oh, they're in it for the money" even though being a doula is obviously very rewarding financially. I believe doulas are doulas because they truly believe that they are providing an important service. So c'mon now. Enough money talk. let's stick to what's best for mom and baby, OK?