While most women in the US use some form of pain relief during labor like an epidural, a growing number are choosing to skip pain medication if they’re having a vaginal birth. Some view birth without pharmacologic pain relief as a safer option for babies and an important choice for women. Choosing to use pain medication isn’t inherently better or worse than a natural birth, but it’s crucial for every pregnant woman to understand the pros and cons of both options so she can make an educated choice on what’s best for her.
Why labor without pain medication?
When I mention the prospect of laboring without pain medication, many women are understandably dubious. Personally, I made the decision to deliver both of my children naturally for a few reasons; for one, I tend to be especially sensitive to medications, so I actually feared the risks and side effects of an epidural more than I did the pain of a natural birth. Also, I had the pleasure of standing by one of my dearest friends as she delivered her baby naturally, and the experience was really beautiful and inspirational. I remember thinking, “heck yeah, I can do this!” But while the natural route was right for me, I support every woman’s right to choose the right path for herself. My goal is to give women all the information they need to make their own personal, educated decisions about delivery.
Skipping pain medication means that you have greater control throughout labor and delivery, remain active and alert, and may experience fewer interventions, such as continuous fetal monitoring or augmentation of your contractions. Natural pain relief options pose little to no risk to your baby. Although pain medications administered correctly and carefully monitored are generally safe for babies, there are a few potential side effects, and it’s important to understand the risks.
Epidurals can make pushing more challenging because they decrease your ability to control the muscles below your waist. Because of this compromised control, an epidural can sometimes result in a forceps delivery or cesarean (C-section) delivery, although lower amounts of anesthesia (aka a “light” epidural) may reduce this risk.
The most common side effect of an epidural is the possibility of lowered blood pressure. And although other side effects are less common, they can include severe postpartum headache, fever, difficulty urinating or walking after delivery, and prolonged labor. One side effect that is rare—but important to be aware of—is the possibility of seizure. Still, millions of women receive epidurals every year without issues, and the overall risk of side effects is low.
In Europe, nitrous oxide, otherwise known as laughing gas, is a milder option that is fairly common. While the University of California at San Francisco (UCSF) has been offering N2O as a pain reliever during labor for over three decades, few other American institutions provide the option. While some experts want more research before N2O is considered a safe alternative for laboring women in the US, advocates point to many anecdotal reports demonstrating its efficacy. It’s been used in the UK for decades and has a long track record of safe outcomes for both mother and child. It’s not yet clear if or when N2O will become more widely available in the US for this purpose, but some midwives also offer it.
What are the disadvantages to laboring without pain relief?
Laboring without pharmacologic support means a higher possibility of pain and discomfort, which may be greater than you anticipate. Some women try for a natural childbirth but remain open to the idea of using pain relief if labor is more painful than they expect. This is a perfectly reasonable approach to natural childbirth, and working with a skilled provider who is supportive of this plan is essential. If you’re planning a hospital birth, research your options and look for a facility that’s supportive of natural birth, or even a hospital that employs nurse-midwives trained in physiologic birth.
What are some natural ways to reduce pain during labor?
Leading up to delivery, it’s important to finalize your birth plan and prepare yourself for what to expect. Hiring a doula and attending childbirth education classes can greatly influence the odds of having the kind of delivery you envision. During the labor itself, many women employ relaxation techniques like hypnosis or visualization, and others rely on techniques including movement, massage, and acupressure to stay focused.
Aside from these methods, here are seven tips and tricks that can help ease the pain and anxiety that can accompany a natural childbirth:
1. Use positive visualization to shift your mental state. Replacing your anxiety with positive thoughts can be incredibly powerful. Whether you conjure a mental image of yourself holding your baby, or visualize your cervix as a rose slowly blossoming, finding and focusing on a beautiful, joyful image can significantly shift your mental state.
2. Create a mantra that makes you feel safe and strong. Take some time to think about a word or phrase that helps you feel powerful and protected, whether it’s a single word such as “yes” or a short phrase that you can utter or simply think over and over again. Your mantra should strike a chord in you and help you to imagine your body overcoming resistance and actually releasing tension. Rather than clenching your body with every contraction, imagine opening as you repeat your mantra.
3. Stay present. This tip is at the core of one of my favorite books, “Mindful Birthing.” Calling on the principles of mindfulness, author Nancy Bardacke emphasizes the importance of staying present moment to moment. Rather than worrying about the next contraction or getting caught up on the last one, focus all your attention on your current reality. Thoughts will creep in and anxieties will inevitably arise; let them pass, and resist the urge to hold on to them.
4. Put the pain into perspective. One major takeaway from “Mindful Birthing” is the reality of the situation. According to Bardacke, for most of labor, contractions generally come about 5 minutes apart and last about 60 seconds each. That adds up to a total of about 12 minutes of actual pain per hour; the rest is downtime. “Can you handle 12 minutes of pain?” she asks. “To get your baby? Of course you can.”
5. Relax your throat. Although there ‘ limited research to support the anecdotal evidence, many holistic practitioners theorize that there is a physiological connection between the cervix and vocal cord tissue. They believe that relaxing your throat and producing low, moaning sounds can help relax your cervix, while expressing your efforts during labor with high-pitched vocalization can actually tighten the cervix, making labor more difficult. If you can, watch a funny movie or TV show that makes you laugh, which will open up your throat.
6. Rest when you can. Pushing through contractions is hard work; there’s no way around that. But the contractions aren’t constant. Between each intense moment, there’s an opportunity to completely relax the mind and body. Close your eyes, sip some water, or go back to your visualization. Or, if you’re up for it, find a way to laugh, dance, and keep your spirits up!
7. Let your endorphins do their job. Our bodies have the incredible ability to produce endorphins, feel-good neuropeptides that very effectively minimize pain. It’s perfectly normal to feel nervous during delivery, but working with your anxiety rather than resisting it can ease the process. Accepting the anxious feelings and surrendering some control over the pain can help you reap the calming benefits of your endorphins. Remember that your body is designed for childbirth and will not subject you to pain you can’t handle. Breathe and imagine endorphins flooding your system as you let go.
Whether you choose to labor with or without medications, when you hold your new baby in your arms for the first time, you will undoubtedly feel like you’ve accomplished an epic, mind-blowing feat. How’s that for a powerful positive image?
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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.
Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. The One Medical Group entities and 1Life Healthcare, Inc. make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.
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