What does Galatians 4:19 mean?

Paul is in anguish. He has said clearly that the false teachers, the ones trying to convince the Galatians that faith in Christ is not enough (Galatians 2:4), are just using the Galatians to make much of themselves (Galatians 4:17).

In contrast, Paul now compares himself to a mother in childbirth. He calls the Galatians his dear, little children. His concern for them is genuine, not a ploy to get them to honor him. In fact, his heart is breaking for them as he is once again attempting to give birth to them, in a sense.

This metaphor of childbirth is not meant to communicate that Paul is the one who has saved the Galatians. Only faith in Christ can cause a person to be born again. Instead, Paul is describing his own emotional experience in suffering and celebrating for the birth of the Galatians when they believed in Christ when he was with them. Now he suffers for them again to escape the false teaching of the Judaizers and fully trust the good news about their status in Christ.

More specifically, Paul describes the moment of childbirth as being when Christ is formed in them. This is a picture Paul paints in his other letters, as well. "Christ in you" is the "hope of glory" (Colossians 1:27). "…so that Christ may dwell in your hearts through faith" (Ephesians 3:17).

The picture is of Christ becoming so prominent in us that He begins to do His work in the world through us, along with all the others in whom He is formed. It's not about us and our works, as the false teachers said; it's about Him and His work in us. Even in our own hearts, Christ must increase and we must decrease (John 3:30).