More than a hundred years after it was first used for labor pains, and decades after it became the go-to pain relief for the majority of American women who give birth, Italian women have finally won the right to an epidural.

Italy is finally adding epidurals to its “essential levels of care,” the list of medical services that the National Health Service is required to cover for all citizens who need them. This change is the result of a grassroots campaign demanding better treatment and pain relief options for Italian women during childbirth. Currently, only 20 percent of Italian women get epidurals, a figure much smaller than rates in the United States or France. Writing for Vocativ, Anna Momigliano explains why Italian women are demanding better care and speaks to a number of Italian women who recount how poorly they were treated while giving birth. Not only are Italian women expected to endure pain due to long held associations between motherhood and self-sacrifice—“as if the pain of labor were atonement for some unnamed sin”—but it’s also common for them to be insulted by hospital staff. One woman recounts being told to shut up while yelling during contractions and was then reminded that she liked it “when [she] spread [her] legs last time.”

Last spring, the NGO Human Rights in Childbirth created a Facebook page called “Basta tacere” (or “no longer silent”) and invited Italian mothers to share their childbirth experiences. They also conducted an online poll and found that 48 percent of respondents said they experienced some kind of abuse during childbirth, 37 percent reported verbal abuse, 24 percent said they were denied help after requesting it, and 22 percent said doctors and nurses refused their requests for anesthesia. Momigliano reports that the campaign has “spurred a heated debate” in the news and on social media, and lawmakers have begun to acknowledge the problem. Last month, lawmakers announced the new rule requiring hospitals to make epidurals available, and last week three members of parliament launched a parliamentary inquiry to the rights of women during childbirth.

While certainly progress, some remain skeptical about how much a difference this will make. Alessandra Battisti, a lawyer in Rome and one of the organizers of the campaign, told Momigliano that she’s concerned that even if hospitals have epidurals there’s still a good chance they will refuse them to a women. The big problem, Battisti explains, is that women are “infantilized. Their complaints about pain and their expressions of concern are dismissed as tantrums … What I’d like to see is for them to be treated like sentient beings worthy of respect and capable of choosing the kind of childbirth that suits them best.”

While some natural birth advocates may claim otherwise, research shows that the vast majority of Americans have a good experience during childcare. According to a 2013 study from Childbirth Connection, 80 percent of American women who’ve given birth rate our maternity care system as good or excellent. Sixty-seven percent of us got epidurals during delivery, and 77 percent of those women reported that they were “very helpful.” This isn’t to say we don’t have our problems in America; our unnecessary C-section rate could certainly be lower, something the medical community is working on. And our rising maternal death rate, which should be a source of deep national shame, needs to be cut. But doing so has more to do with combating chronic diseases like heart disease and diabetes than changing delivery protocol.

There are still some cases of severe mistreatment, or what some call “obstetric violence,” in the U.S. Just this week a woman won $16 million dollars in a lawsuit against a hospital for forcing upon her a delivery that left her with a debilitating nerve injury and psychological trauma. There have been a handful of other legal cases in recent years involving women who were harmed during delivery at hospitals, along with cases of neglect involving women who had homebirths or delivered at birthing centers. But severe abuse and neglect during childbirth remain anomalies in the U.S.

Unfortunately, much of the fight for better treatment of women during delivery in the United States has been led by advocates who find medical interventions unnecessary, unnatural, or even evil. They believe that women should “trust their bodies’ inherent ability to give birth without interference,” (even if medical history tells us otherwise) and see natural childbirth as a source of empowerment that no woman should be denied. There are other advocates who believe birth can be improved through the creation of better medical technology, but there are far fewer of them than natural birth advocates. The plight of Italian woman, many of whom can’t rely on medical technology even if they want to, is a reminder that a good birth isn’t necessarily intervention-free or even empowering. A good birth is one where a woman feels both listened to and safe. That’s what all women should be fighting for.