-T OR OVER one hundred years, since James Simpson first introduced anesthesia as an integral part of obstetrical practice, research has been directed toward making childbirth a more comfortable and happy event. Now the fashion in obstetrics is changing and a new philosophy threatens to undermine that progress. It is no longer considered smart talk at the bridge table to discuss twilight sleep or painless labor. The woman of the day is one who can vividly describe every last detail of her delivery, including the ecstasy of the unassisted expulsion of the placenta. Doctors and patients alike are once more engaged in a debate over the following issues: Is pain in childbirth a culturally induced phenomenon? Must patients actively participate in the delivery? Are expectant mothers entitled to the benefits of modern analgesia and anesthesia? And is it psychologically damaging to either the mother or the child to be delivered in a state of unconsciousness? For the past 3 years we have been engaged in a study of the natural childbirth program. During this period we have not only investigated the dynamics of the procedure in our own clinic, but we have also observed it in practically every community where the program has been in operation. Some of the conclusions we have reached from this study are