Eve's curse : intolerable unrelieved pain in labour : necessary evil or medical negligence?

For most prospective mothers, pain in childbirth is their greatest fear. However, intolerable labour pain should no longer be accepted by the health professions. Without adequate pain control in labour fetal damage can be significant. Moreover, if relief from pain is a fundamental human right then surely standards of good obstetric care should include a definition of adequate pain relief in labour and obstetricians should pay due attention to alleviating that pain. At present actions in tort focus on poor medical management of injuries or diseases. Pain and suffering are generally a secondary consequence of that negligence although in the tort of negligence pain can constitute damage. However, it is argued that failure to address pain adequately as a primary issue should be considered medical malpractice or at least unsatisfactory professional performance if there is proof of failure to exercise reasonable care. The possibilities for untreated labour pain to be deemed medical negligence could include maternal post-traumatic stress disorder, fetal brain injury resulting from maternal acidosis and utero-placental hypo-perfusion or even negligent infliction of mental harm on the family members witnessing their family relative in intolerable pain. In this article the nature of labour pain and its fetal effects will be discussed. Effective pain control in labour should be good medicine as well as humane treatment.