I didn't have an epidural, but I did have just one shot fentanyl and it was fine.  One big downside of epidural pain relief is that you're pretty much paralyzed for several hours even after you give birth whereas  I was able to walk myself to the bathroom and take a shower right after I gave birth.    This study doesn't seem to say what other pain relief these women had and also what kind of prenatal education they had.  In my prenatal classes they talked about all kinds of pain relief and labor methods and said to choose the one you think is right for you.  I'm wondering what kind of prenatal education the more educated Canadian women had.  If they had a class that told them epidurals are the best thing ever then I would imagine more of them would choose it.  I don't know if it's a cultural bias or not. 

I am well educated and I chose not to have an epidural. But I do feel that all women, regardless of background, should have the same options.

If I were to guess, I would have expected that more high-income, more educated women would refuse epidurals just as they are more likely to breasfeed. I wonder if these same results would hold true in the US; most although not all of the natural childbirth-leaning women I know are pretty well educated.
In wonder if epidurals are routinely offered in Canada as they are in the US? If it something you have to specifically ask for I can see why less educated women, lower income might not get them.
Personally, I think they should be more of something that is to be asked for instead of unilaterally offered, unless the nurse or doctor observes that the patient is experiencing a lot of pain. Not that I feel they should be withheld, just that the upfront suggestion that pain medication will be necessary is not helpful when anxiety and expectations can play a significant role in how much pain is experienced.
And by the way, I had one kid with epidural and two without.
Carrie Kirby blogs on ParentingSquad, www.chicagonow.com/frugalista, www.myfunnyfunnyfamily.com and www.chicagomomsblog.com.

I think the take home message of this study is that "women are dumb for not getting an epidural." That's certainly what most doctors, nurses, and tons of other people will say: "Get the epidural!" "You're going to need the epidural!" Well, maybe you won't. Maybe they didn't either, and just went on the basic assumption that 'all childbirth is unbearable and painful, no matter who you ask.'

Every woman's labor is different. I had a half dose of Nubain and only thought about the epi once, and decided it was too late for it. There are so many factors this study didn't even mention that should be considered. I never got the impression that the choice wasn't offered to them; if that were the case, then the OBs in this study were behaving extremely unethically. In no way should you refuse a woman pain medication if she asks for it, regardless of her education or financial background. If that isn't the case, then I'd say that more education isn't necessarily better.