A person may choose to give birth naturally, without pain management medication, or with an epidural to block sensations of pain in the lower body. Each birthing option has its potential risks and benefits.

This article explores the benefits and drawbacks of giving birth naturally or with an epidural. It compares the options and looks at alternative ways to manage pain during birth.

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People may use the terms “unmedicated” or “natural” birth to refer to a vaginal birth without an epidural or other pain medication.

A person may choose to have an unmedicated birth for a variety of reasons. They may also be unable to opt for anesthesia or pain relief for health or other reasons.

An epidural involves a healthcare professional placing a catheter into the space below the spinal cord to administer doses of anesthetic.

The anesthetic blocks pain signals from the spine to the brain, preventing the person from feeling pain in the lower body during labor and delivery. The individual may receive an epidural for a vaginal or cesarean delivery birth.

The table below outlines the potential benefits and drawbacks of birth without medication and birth with an epidural.

Unmedicated birth· control over birthing location

· ability to walk and move freely during labor

· can avoid some of the risks of epidurals and cesarean delivery

· ability to push more easily in the final stages of labor

· possible shorter labor and recovery time

· potentially less need for medical intervention

· does not require an anesthesiologist

· may give some people a feeling of accomplishment
· severe pain and potential trauma

· prolonged labor

· unwanted medical interventions and medications — cesarean delivery may still be necessary

· risks of vaginal birth, such as infection, failure to progress, and excessive bleeding
Birth with epidural· fast, effective pain relief

· pain relief is adjustable

· an epidural with a preplanned cesarean delivery may be less stressful than a vaginal birth or emergency cesarean delivery

· may help a person have a less stressful, traumatic, and exhausting birth experience
· inability to walk around

· risk of low blood pressure, which may affect the baby’s heartbeat

· headaches, backaches, nausea

· risk of higher risk of medical intervention and assisted birth

· difficult to push during the final stages of a vaginal birth

· risk of nerve damage

· temporary loss of bladder control

· difficulty urinating

· fever

· itchy skin

· very low risk of convulsions, difficulty breathing, and death

Both approaches to labor have benefits and drawbacks, and a person’s choice should derive from their circumstances and preferences. The following sections outline the advantages and drawbacks of each labor method.

Unmedicated or natural birth

A person may choose to give birth without medication for a variety of reasons. They may wish to deliver outside a hospital setting and feel more in control of the birthing experience. They could also be fearful of the potential risks of medication for them and their child.

For some people, the option of birth with an epidural or another method of pain management may be unavailable or unsafe.

The benefits of an unmedicated birth include:

  • having greater control over the birthing location, as a person may choose a home or water birth, a hospital birth, or a birthing center
  • providing someone with a sense of accomplishment
  • not requiring an anesthesiologist
  • avoiding the potential risks of an epidural
  • avoiding the potential risks of a cesarean delivery birth
  • being able to move around more freely during labor
  • being able to push more easily during the final stages of birth
  • potentially requiring less recovery time and medical intervention

The drawbacks of an unmedicated birth include:

  • experiencing severe pain, which may negatively affect a person’s experience of childbirth and could lead to psychological trauma
  • having to undergo prolonged labor due to exhaustion and stress
  • requiring medication and other interventions at some point in the birthing process, despite going without them initially
  • needing an unplanned emergency cesarean delivery in the case of a medical emergency

If a person gives birth vaginally rather than via cesarean delivery, risks can include:

  • having an increased risk of infection
  • experiencing failure to progress, in which the fetus does not move through the birth canal
  • postpartum hemorrhage, or excessive bleeding following the birth

Read about vaginal changes after giving birth.

Birth with an epidural

Epidurals are the most common type of pain management for childbirth in the United States. They are highly effective at relieving pain in the lower body and allow a person to remain awake and alert during the birthing process.

A person may not be able to receive an epidural if they are allergic to anesthetic or if they have had prior spinal surgery.

The benefits of birth with an epidural include:

  • getting fast, effective pain relief within 10–20 minutes of receiving the anesthetic
  • being able to remain alert and awake throughout the birthing process
  • being able to receive adjustable pain relief as necessary
  • receiving safe pain relief, as there are no known long-term health risks

The potential drawbacks of giving birth with an epidural include:

  • being unable to walk around
  • experiencing low blood pressure, which may affect the heartbeat of the fetus
  • experiencing headaches and backache
  • increasing the risk of requiring assisted delivery
  • prolonging labor and making it difficult to push during delivery
  • feeling nauseous
  • experiencing nerve damage
  • having temporary loss of bladder control
  • experiencing itchy skin
  • experiencing fever
  • having difficulty urinating

Very rarely, a person may experience severe side effects of an epidural, such as serious breathing difficulties and convulsions.

Read about common labor complications.

Epidurals are not the only way to manage or relieve pain during childbirth. There are other medical and natural methods, which someone can discuss with their doctor.

Medical options

Medical pain relief options include:

  • Opioids: Medications, such as morphine and remifentanil, can help relieve pain during birth. Doctors do not typically administer opioids close to delivery, as they may affect the heart rate and breathing of the fetus.
  • Pudendal blocks: A pudendal block is an injection to relieve pain in the vulva, vagina, and perineum, the latter of which is the area of skin between the genitals and anus. A doctor may administer the injection near the time of delivery to relieve pain from a tear or surgical cut.
  • Nitrous oxide: A person may inhale nitrous oxide, which people also refer to as laughing gas, via a mask throughout labor and delivery. The gas can provide pain relief but may cause nausea and a feeling of grogginess.

Pain relief without medication

Nonmedicinal pain relief options may include:

Giving birth is a personal experience, and many factors may influence a person’s birthing decisions. In some cases, their decisions may change during the birth process, or certain health implications may require them to proceed differently from what they expect.

The experience of birth can also vary and may depend on an individual’s pain tolerance, overall health, and the size and position of the baby.

Natural birth and birth with an epidural each have potential benefits and drawbacks. A person can discuss the options with their midwifery team.