Natural Childbirth versus Epidural

March 11, 2010

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Natural Childbirth versus Epidural

by Marjorie Greenfield, M.D.
reviewed and revised by Marjorie Greenfield, M.D.

When I talk to pregnant women about their plans for childbirth, some are very clear about what they want, while others are not so sure. The range of responses I get to my questions is amazing, from "I live in the twenty-first century. Why would I want to labor like an animal? Give me drugs!" to "Women have given birth without drugs for centuries. I don't see why I can't do it. I want the full experience."

There isn't a "right answer" to these questions, but understanding your own values and priorities, psychologically preparing for the experience, choosing and educating your helpers to support your goals, and setting the scene for success can help you towards the birth experience that you are seeking.

The argument for epidural

An epidural generally takes away or at least diminishes the pain of contractions. When labor gets very intense in the active phase, and especially in transition, women with epidural anesthesia seem more relaxed and more "themselves."

I have heard people say they don't want an epidural because they don't like the idea their legs might be weak or numb: they want to feel "in control" of their body. But if feeling in control is important to you, you may well want an epidural. The emotional experience of un-medicated labor and childbirth usually feels anything but controlled. Pushing with an epidural is sometimes pain-free and sometimes still painful, but in general, people find pushing less distressing (although sometimes more exhausting) than without anesthesia. Since pushing may be less effective with epidural, you may push longer and may be more likely to end up with an operative vaginal delivery by vacuum or forceps.

There are no martyr awards for avoiding pain medication, and the end result, a baby in your arms, happens regardless of your choice of anesthesia. In most situations, the decision is purely a personal choice.

The case for natural childbirth

Un-medicated natural childbirth is not for everyone. Many women know they have no interest in the "full, primitive, animal experience" of giving birth. Natural childbirth can be an incredibly intense experience analogous to running a marathon or climbing a mountain. Why do it?

Your experience can be more self-directed and less medical if you avoid epidural. Epidural requires an IV, electronic fetal monitoring and usually bedrest. Without epidural, if all is going well, you should be able to move around freely, go in the shower or tub, and you may be less likely to get pitocin, vacuum, forceps, and some other medical procedures. It is as nature intended.
Like climbing a mountain, if natural childbirth is a goal you have set for yourself, meeting the challenge (and becoming a mother simultaneously) is a powerful experience which often gives a tremendous sense of achievement.

Regardless of your preferences, it is a good idea to keep an open mind and prepare for what comes. Maybe your labor will be so rapid that you will arrive at the hospital with your cervix 8 centimeters dilated, and will give birth quickly. Maybe there will be numerous emergencies when you arrive on the labor and delivery unit, and anesthesia won't be immediately available.

Or maybe you will have a long, exhausting labor. Your practitioner may get the sense that your anxiety or fatigue is playing a role in labor's poor progress. He or she might then recommend an epidural as a treatment to try to get your labor moving. An open mind will help you to reassess the pros and cons of the options, and cope with the unexpected.


RELATED INFORMATION

			Pitocin: Friend or Foe?
			The Emotional Stages of Labor
			Childbirth Preparation
			Events of Birth
			Epidural

Created September 22, 2000
Reviewed and revised April 14, 2003

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