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Natural Birth vs Epidural: What to Expect *

There are so many ways to birth your baby! Whether you want a birth that is vaginal or a planned cesarean, in a hospital, birthing center, or at home, with a midwife or OBGYN, with the support of a birth doula and/or partner, to give birth while squatting, side-lying, or any one of many positions that you can birth your baby…there are so many things to think about! But one of the biggest questions facing expecting families is whether or not they want to use pain medication. It is important to note that while the term “natural birth” exists in the zeitgeist, we recognize that ‘natural’ is a completely loaded word; what we hope for are positive birth experiences based on informed consent, regardless of how your child comes into this world!

This article is meant to clarify the epidural option as compared to other, non-medical approaches to pain management during labor. It is important to know what your choices are so that you can make confident decisions based on your actual preferences, rather than based on fear, lack of knowledge, or based on what other family members or your care provider want for you. While you may write these preferences down in your birth plan a.k.a your birth preferences sheet, you should know that at any point in your labor, you have the authority to change your mind and do something completely different! Your birth preferences sheet is a way to share what you want with the people supporting you, but it is not a contract. In most cases, if your desires change during labor, you have the right to change the direction of your birth.

What is “Natural Birth”?
The definitions of natural birth that you receive from people vary widely and the answers you get will depend on who you ask. For some people, it simply means a vaginal birth. For others, it means a birth that is unmedicated or intervention-free and for some, it means all of the above or some variation on these. This is why, when talking about the kind of birth that you want for yourself, it is important to be specific. In this case, we will be addressing the most common use of the term “natural birth” as meaning when a person does not use pharmacological pain medications.

What are the Benefits of Having an Unmedicated or “Natural Birth”?
Some people use the language “natural birth” to be a birth where the baby passes through the birth canal. Although we are not assuming that in this article, In that case, some benefits include a shorter hospital stay, a boost in the baby’s immune system because of the healthy bacteria they encounter in the birth canal, improved lung development, and increased skin-to-skin contact.

If you mean the phrase to be unmedicated birth as we are assuming for this article, some of the benefits include:

You will more easily be able to choose a variety of positions and will have more access to nonpharmacological pain management like the shower or the bathtub.
You will fully experience childbirth and all it entails, which for some, is very enticing, empowering and enlivening. Like setting out to run and finish a marathon or climbing to the top of a high mountain peak, the satisfaction of personal achievement and making it through something incredibly difficult and coming out on the other side is exhilarating.
Unmedicated birth allows the full release and production of your own hormones including Oxytocin (which produces contractions, feelings of love, Feelings of well-being, interconnectedness, and encourages deep bonding) and beta-endorphins which help us perceive our pain differently, similarly to runner’s high. Is extremely satisfying
Some people who give birth without pain medication report extremely positive and up feelings, which are associated both with a sense of achievement and with the significant amount of oxytocin circulating through their system.
You are less likely to experience a cascade of medical interventions
Finally, you will not have any of the side effects of medications like grogginess, itching, headache, back pain, being confined to bed, etc. (including any that your baby may also experience), which may increase your success with breastfeeding/chestfeeding.)

What Does it Feel Like to Have a “Natural Birth”?
Just as the experiences of conception and pregnancy can be very different from person to person, the experiences that have been reported of vaginal, unmedicated births are wide and vast. Most people describe vaginal childbirth as being very intense to painful. Some report a very easy birth, sometimes called a “butter birth” (when a laboring person reports little to no pain and has short labor with no tearing or excess bleeding), some report having an orgasmic birth, and many reports that labor or delivery included the worst pain they’ve known.

Contractions get described in a variety of ways, such as rumbling, intense menstrual cramps, strong hunger pains, abdominal tightening, constipation feelings, like an inflated ball inside your womb expanding and deflating, stabbing, sharp, dull, torturous, amazing, powerful, and so much more. While all experiences are worthy of acknowledgment, no one else’s story will determine your own. How you experience childbirth is a deeply personal experience! In fact, it is very likely that the stories you have heard throughout your lifetime about birth will influence how you experience labor. This is why pregnancy is a wonderful time to seek a variety of stories. You will learn that while some people have extremely challenging experiences, others enjoy and feel positive sensations during their labor.

How Can I Have a “Natural Birth”?
No one can predict the type of birth that you will have. Nevertheless, there are some things you can do to set yourself up for an increased likelihood of a natural or unmedicated birth if that is what you seek.

  1. Hire a midwife to deliver your baby if you are low risk.
    Midwives are trained in physiological labor and have significant experience with people who do not want to use pain medication during childbirth.
  2. Choose a birthplace that is supportive of unmedicated or natural birth.
    Consider a homebirth or a birth center where pain medications are not routinely offered or available. If you choose to birth in a hospital, You can still have an unmedicated birth, but it is not the norm in the hospital and you must be ready to assert your desire strongly.
  3. Work with a care provider (or switch to one who does) who supports you and your desire to have a natural or unmedicated birth.
    If your doctor does not believe in not using pain medications, it will be very hard to have an unmedicated birth with that care provider. It is common for care providers to continually push epidurals on their patients if they prefer their patients to have a medicated labor.
  4. Take childbirth classes.
    Some childbirth classes focus on nonpharmacological pain relief so that you can learn all of the potential methods and get into a pain-coping mindset.
  5. Hire a doula.
    The best thing you can do to help yourself have a successful natural childbirth experience is to hire a birth doula. A birth doula is well-versed in comfort measures for childbirth and can be very encouraging due to their knowledge and trust in the birth process. Some of what makes childbirth so difficult can be fear and negative associations with birth. However, since a birth doula is an expert in the process of birth, they can help you learn more throughout your pregnancy to ease your worries and uncertainties. Your birth doula will then join you as you labor, and be there with you continuously, caring for you, as you experience the surges and waves of contractions. Even if you are very prepared, a lot of what you learned can go out the window during the intensity of labor. A birth doula can be your second brain, remembering your goals and preferences and helping to support you through your birth. Research shows that hiring a doula has many positive impacts on birth outcomes including fewer requests for pain medication.

Can Anyone Have a “Natural Birth”?
Most pregnant people are able to have a natural childbirth if they want one. It is very rare that an epidural or other pain medication would be recommended for the safety of the birthing parent; Although there are possible situations where the laboring parent is experiencing high blood pressure and an epidural may be recommended to try and bring the blood pressure down. Another possibility is that you do have a complication which makes you a candidate much more likely to need a cesarean birth, in which case they may recommend that you have an epidural so that they don’t have to give you in an emergency. Chances are that you are able to have a natural childbirth experience if you want one. Talk with your healthcare provider to be sure they support unmedicated birth and if not, consult with a different midwife or OBGYN.

Why Wouldn’t Someone Want a “Natural Birth”?
Although, for most of times, people gave birth without pharmacological pain medications, it is currently not very common in the US. Many hospitals have a 90% epidural rate. You may not know anybody who gave birth physiologically without pain medications. Fear or anxiety about experiencing the pain of labor is the most common reason. A desire for a controlled, calm experience may be present as well.

What are Some Non-medical Pain-Relief Methods?
There are many ways to try to reduce the pain you may experience during labor! For many people, it is a truly instinctive act that will involve breathing, making sounds, moving around, finding a rhythmic motion, picking positions that make labor feel more comfortable to you, getting into a shower or bath, and simply following your body’s urges as you go deeper into labor. You may also try practicing deep breathing, meditation, hypnobirthing or self-hypnosis, repeating affirmations, walking, squatting alone or with a squat bar, crawling on hands and knees, standing, dancing, stomping, leaning on someone, using a birth or peanut ball, or laying down on your side or stomach (usually with pillowing). You might rely on external physical manipulations known to help with labor like receiving hip squeezes, counter pressure (especially on the lower back), pressure point or general massage, acupressure points, stroking, ice, heat packs, or a fan. You could try a sensual massage from a partner or yourself, including the use of hands or a vibrator to release more oxytocin which both reduces pain in labor and speeds labor along. If this seems a bit overwhelming, consider hiring a doula who can provide and suggest comfort measures and pain relief techniques for birth while you focus on the work of labor.

What About Medical Pain Relief Methods like an Epidural?
An epidural is a hospital procedure offered during labor where an anesthetic is injected into the “epidural space”, an area right outside the membrane which protects your spinal cord, in order to provide numbness from the lower ribs down. If you chose to receive an epidural, you must sign a consent form indicating that you have been made aware of the risks. After insertion, you will use a remote on the side of your bed, which controls how frequently you receive all subsequent doses – and they are set up so that you can’t overdose! See an epidural administered here.

What Are the Side Effects of an Epidural?
Some of the most common side effects of using an epidural during childbirth are itching of the skin, nausea, vomiting, low blood pressure, difficulty urinating, fever, soreness at the site of injection, and slowing of labor. The medications used in an epidural can also transfer to your baby in small amounts depending on how long you are on the epidural. In some cases, it can make your baby sleepy or sluggish at birth, which may negatively impact the initiation of breast/chestfeeding. Read more about the effects of an epidural on nursing here. If breast/chestfeeding is important to you, find out when your hospital lactation consultant is on shift or if there are any nurses who are especially knowledgeable about lactation so that you can receive support as soon as possible. Epidural or not, if you are struggling with lactation, consider working with a lactation consultant after leaving the hospital since time is of the essence when it comes to bodyfeeding.

What Does It Feel Like to Have an Epidural?
Most people who receive epidurals report having little to no sensation below their waist after about 30 minutes. While that may be the desired outcome, it isn’t a guarantee for all people, as sometimes epidurals fail or work at different degrees for different people. If it doesn’t work perfectly for you, your support person can continue to offer comfort measures, emotional support and pain relief techniques.

Can I Walk Around With an Epidural?
Although it is called a “walking epidural,” you cannot expect to have complete control of your legs and must stay in bed for your safety in almost all cases. Although you may not be able to walk around, many positions are still available to you and are highly encouraged. The peanut ball is a great tool to use when you have an epidural in order to create space between your legs and hips and to help shorten labor and make a vaginal birth more likely. Many laboring people are able to labor and birth their babies in various upright positions which can be more effective and comfortable for you, shorten your labor, and make vaginal birth more likely.

Why Would Someone Consider Getting an Epidural?
The biggest reason to get an epidural is for the fairly reliable pain relief it provides. Some providers may require an epidural for special cases, like the delivery of twins (although Plenty of providers do not require this for twins). If you are hoping to birth without an epidural be sure to interview your care provider to find out if they support it.

What Are Some Other Pain-Relieving Medications?
There are many medications for pain management that may be available for you besides an epidural: Nitrous Oxide (laughing gas), Sterile Water Injections, IV medicines such as meperidine (Demerol®), morphine, fentanyl, butorphanol (Stadol®), and nalbuphine (Nubain®). Speak with your midwife or doctor about the risks and benefits to see which of these may be best for you. In addition, you can also watch our recorded class on epidural, IV medications, and NO2.

What is Most Important?
There is no right or wrong way to birth your baby. All births are worthy and should be celebrated, and you should never be shamed for the type of birth you choose or end up having!

After thinking about what is important for you to achieve and experience in childbirth, you can write a birth preference plan that demonstrates how you hope your birth will go.

Your baby and your body will be the most important factor in whether or not you can have an unmedicated birth; the second most important factor is who you choose as your care provider and where you choose to give birth.

Hiring a doula is another great way to achieve the birth you envision for yourself. They will support you and advocate for your goals, no matter where or what type of birth you have: a c-section, natural, medicated, epidural, unmedicated, at home, in the hospital, and everywhere in between.

*Article courtesy of BOOBER (NYC)

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