Labor pain management in the United States: understanding patterns and the issue of choice.

We reviewed a considerable body of literature in an attempt to characterize the patterns of managing pain in US childbirth. In doing so, we noted the relatively restricted range of choice most US women have in this situation and the limited amount of information available about what US women prefer, the reasons for their preferences, and what influences them. What is clear is that the range of choice available is substantially narrower than in many of the advanced industrial democracies of Western Europe. The reasons for this include professional training, economic rewards, staffing constraints, and understandable inclinations to avoid pain. What is not clear is what could be done to increase women's choices. Simply supplying more information, however accurate, will surely be inadequate. Changes in training programs could make a difference, as would shifts in payment. There are, however, deeper cultural forces at work that are less open to direction.