Updated on: Mar 15, 2023

I remember having a conversation about unmedicated birth vs. epidurals with a frenemy when I was pregnant with my first child. She had just had a baby, and when I mentioned my plans to go unmedicated, she laughed and said, “Good luck! I tried that with my birth and was in so much pain, I was begging for the epidural.” 

As if I didn’t have the strength to do it. 

Those words made me more determined than ever to go unmedicated, if even just to prove her wrong (I might have a slightly competitive nature). I had taken a hypnobirthing course, practiced my meditations every night, and was mentally ready. Well, you know what they say about the best-laid plans… 

When it came down to it, I developed preeclampsia, was induced at 36 weeks, got an early epidural because they were worried about my blood pressure rising, and the anesthesiologist was about to go into surgery. After 12 hours of labor, I was deemed failure to progress and whooshed off for a Cesarean.

Not only had I NOT gotten my unmedicated birth, but I also had pretty much every intervention possible! Humility much? Yeah. Since then, I became a doula and had three unmedicated home births after my c-section. I have learned that deciding between having a unmedicated birth or an epidural is not black and white. Many factors come into play, and sometimes, plans need to change. 

In this blog, we will go over the pros and cons of natural birth vs epidural, talk about why you might choose either, and get you ready to change plans if it becomes necessary. 

What is an epidural? 

An epidural is an injection in the back to stop the feeling of pain in a specific part of the body. An epidural is used for many types of pain management. 

Epidural anesthesia is the type of epidural used in childbirth for pain management. It blocks the nerves that signal pain to the brain and causes numbness and tingling in the chest, abdomen, and legs. 

How is an epidural administered?

An anesthesiologist or an anesthetist administers an epidural while you are awake, and often when you are in active labor. You’ll be required to remain very still while the epidural is being administered, which can be difficult during contractions.

The epidural administration process goes as follow:

1. An IV will be placed, if it hasn’t already, to ensure you are receiving fluids and staying hydrated after the epidural takes place. 
2. You will either sit on the edge of the bed, hunched over, or lie down on your side, with knees curled up to your chest. 
3. Typically, you will be given a local anesthetic to numb the area where the epidural is being placed. 
4. A needle will then be used to insert a thin plastic tube (epidural catheter) into your back and sit near the nerve that carries pain signals to your brain. 
5. The needle is then pulled out, leaving just the catheter in place. 
6. The other end of the catheter is inserted into a machine that keeps a constant medication dose flowing until it is removed. 
7. Typically, you will feel relief build up with each contraction for 20-30 minutes to feel the epidural’s full effects. 
8. Some anesthesiologists will lower the dose, at your request, of the epidural to maintain some mobility in your lower extremities to make it easier for you to change positions while you labor. 
9. Once the epidural is removed, it will take several hours before the effects wear off, and you can return to full mobility. 

Epidural vs unmedicated birth statistics and safety 

There is a lot of misunderstanding about unmedicated birth versus epidural injections, even to the point of confusion in the terminology itself. Let’s go over some statistics and information to clear up each type of birth’s risks, benefits, and safety. 

Are epidurals safe?

Epidurals are usually safe and effective; however, they are not risk-free. Using a decision-making process, like B.R.A.I.N, can help you assess these risks and make a confident decision. Below, we’ll consider the risks and benefits of epidurals. 

The benefits of an epidural

For most birthing parents, epidurals provide complete relief from the discomforts of labor. It can be especially helpful for parents who are enduring a long, complicated, or otherwise exhausting labor, or whose minds are overly anxious or scared of giving birth, which can hinder the birth process. 

An epidural can help you stay present while in labor. Going without pain relief takes more mental focus, and the strength of contractions can be unbearable for some, causing them to look back at their birth with a negative view. 

In my doula practice, I have helped clients labor for long hours with slow progression and reach a completely exhausted state. Often, after receiving an epidural, they can get a good 1-2 hour nap, and wake up to push a baby out soon after. It can be an excellent pain relief option when it is effective. 

However, The Obstetric Anaesthetists Association estimates that 1 in 10 parents with an epidural do not get full pain relief and need other pain management methods. 

The risks of an epidural

Aside from the temporary pain from the needle poke, and the sensations of numbness, heaviness, and tingling, there are other epidural side effects to be aware of. 

Common epidural side effects:

• Not working effectively for labor: 1 in 10
• Not working well enough for a Cesarean: 1 in 20
• A significant drop in blood pressure: 1 in 50
• Severe (spinal) headache: 1 in 100
• Possible stall in labor

Uncommon epidural side effects:

• Nerve damage (numb patches on the body or weakness): 1 in 1,000
• Nerve damage lasting more than six months: 1 in 13,000
• Infection at the site of the epidural: 1 in 50,000
• Meningitis: 1 in 100,000
• Accidental unconsciousness: 1 in 100,000
• Epidural blood clot: 1 in 170,000
• Severe injury including paralysis: 1 in 250,000

You can read more about the side effects and complications of an epidural on the Epidural Information Card. 

Epidurals can also slow down the second stage of labor, leading to other interventions including Picotin, internal fetal monitoring, sleepy baby, vacuum or forceps delivery, and even Cesarean birth. Parents who have an epidural are almost three times more likely to have an unplanned Cesarean birth. 

If you are considering epidural for a VBAC, the epidural can make it harder to identify a uterine rupture. You will be connected to constant fetal monitoring to ensure the baby is tolerating labor well and that everything is going smoothly. 

Definition of “unmedicated birth”

Some people refer to an unmedicated birth as a “natural birth.” We try to stay away from that term because all births are a natural process, whether you decide to get an epidural or not.

In this article, we use “unmedicated birth” to describe birth without an epidural. 

Benefits of unmedicated birth

There are many benefits, both physiological and psychological, of unmedicated birth, including:

• The ability to move freely helping the birth process along
• More likely to have a stronger immediate connection with your newborn
• The ability to labor in the water or shower, or floor, or car or, well, you get the idea…
• Feeling the sensations of labor reduces your likelihood of severe tearing
• Labors are typically shorter without an epidural as epidurals can slow the second stage of labor
• Quicker recovery from childbirth
• Avoiding unnecessary interventions
• May reduce the need for a Cesarean birth
• Increased instances of long term breastfeeding

Read more in-depth about all of these things in our article on the benefits of natural birth. 

Risks of an unmedicated birth

The risks of an unmedicated birth are minimal, but important to be aware of. The first risk is obvious — you feel all the sensations of childbirth. 

Some parents describe these sensations as pressure, intense, extreme, and painful. These are things you will need to mentally prepare for far in advance. A contraction’s intensity typically lasts for one minute, with two to five-minute breaks in between. Having proper coping tools and the right birth team is crucial. 

Also keep in mind that after an unmedicated birth you may feel sore right away or If there is any retained placenta this could also cause some trauma or discomfort. 

The potential for birth trauma associated with pain is higher for unmedicated births. While birth trauma happens during all types of deliveries, a faster than expected unmedicated birth can be incredibly traumatic to process through. If you feel overwhelmed by the contractions and your coping tools are not working, it might be a good idea to ask for an epidural. 

What it’s like to have an unmedicated birth with no epidural

With the skyrocketing Cesarean rate and higher incidences of birth trauma in parents, women birthing today are going back to their roots in childbirth. My doula clients all tend to express similar birth goals.

They want to be free to move around as much as possible. Dancing and rocking out to pop-star Pink or doing the Cupid Shuffle are fun ways to encourage labor’s natural progression! 

Many women don’t want to be tied down by IV poles and monitors. They like to labor at home as long as possible in a comfortable environment, with fewer distractions, and little or no cervical checks. The husbands’ support during labor is important.

After the baby is born, they want to be alert and have immediate skin to skin contact, and to delay cord clamping until the cord isn’t pulsing anymore.  

Parents are beginning to trust the natural birth process again. They want to labor and push in positions other than on their backs, and not until they are red in the face with nurses counting while they bear down.

Many parents are searching for a more empowered birthing experience. They want to trust their instincts and be confident in their birth choices long after their baby is born. When interventions are needed, they want to know that they are necessary and discuss all options before choosing which path to take. 

Unmedicated birth at a hospital is possible, with the right provider and the right location. Discussing your birth plans with your provider is an essential part of preparing for birth, whether unmedicated or with an epidural. 

One of the mistakes my frenemy made when trying to have an unmedicated birth is that she didn’t mentally prepare for labor. Making plans for dealing with the sensations of labor is an essential part of your birth preparation process. 

Some parents choose to give birth with a midwife at home or at a birth center where their providers are natural childbirth experts. However, having an unmedicated birth at a hospital, with a provider who trusts the natural birth process happens, too. 

Taking a childbirth preparation class can help you become knowledgeable about the birth process overall so you can anticipate what is coming up. This is helpful, whether you are planning to go unmedicated, or planning on getting an epidural. We offer a VBAC specific preparation course that covers all of this specifically for parents preparing for birth after Cesarean. 

Hiring a doula to be part of your birth team is an excellent way to get informed of all the coping tools available for use, not to mention the other benefits that come with having a doula. 

Other coping tools you can use to prepare your body and ease labor sensations include:

• Chiropractic care
• Prenatal massage
• Warm bath or shower
• Moving and changing positions frequently
• Learning and practicing breathing techniques
• Doing The Miles Circuit
• Spinning Babies® Daily Essentials

Should I get an epidural? 

We often get asked, “Can I VBAC with an epidural?” The answer is YES! You absolutely can. 

I have seen it many times as a doula, and I have even seen epidurals change the course of labor so that vaginal birth was possible. I have also seen epidurals slow labor down, and births end in a Cesarean due to the labor not progressing. 

Here is the thing; birth isn’t one size fits all. We have many coping tools available to help us get our babies here safely, and with an experience we are happy with. 

There is no medal awarded for those who suffer the most during labor. If you are struggling, exhausted, or simply ready for relief, there is no shame in asking for an epidural. There is no shame in planning to get one in the first place, either. 

Who shouldn’t get an epidural?

In some circumstances, you might not be able to get an epidural due to certain medical conditions or medications you may be taking. Consult with your provider if any of the following criteria apply to you:

• You have low blood platelets
• You are on any type of blood thinner medication
• You have low blood pressure
• Allergies to anesthesia
• Blood clotting issues
• Uncontrolled diabetes

Ensure your provider knows all the medications you are taking. Some may have consequences and risks that would prevent you from safely receiving an epidural. 

Unmedicated Birth vs Epidural: Choose what makes you comfortable 

Childbirth is unpredictable and should be customized based on the individual birthing person’s needs and preferences. 

Plan and prepare for the birth you want, but have a plan B, C, and even D, because odds are, it won’t go exactly as you planned it. It is best to know and understand birth options and know when you might need an epidural or other interventions to help your baby enter this world safe, happy, and healthy.

To help you prepare for birth, no matter what method you choose, we created the most comprehensive VBAC preparation course in the world, perfectly packaged in an online, self paced video course.

Enroll now and get started right away How to VBAC: The Ultimate Prep Course for Parents.