Medicated or Unmedicated Labor: Information to Help You Choose

Even if you’ve heard about and talked to other women who used epidurals during labor, you may still be unsure as to whether or not this is a good fit for you. Below are the pros and cons to help you get some information to base your decision upon. 

Whether or not you decide to use pain medication for part or all of your labor and delivery is a very individual choice. Although others may be quick to advise or tell you what you should or should not do, at Diana Health, we want to educate and empower you so that you can make the best decision for you. Also, as your healthcare team, we are here to talk with you and support you every step of the way. We welcome your questions and the opportunity to converse thoughtfully with you. Below are pros and cons of each decision to help you make an informed decision on the kind of labor experience that’s right for you!

What is an epidural?

An epidural is a way of receiving medication into the space around the spinal nerves in a woman’s lower back, blocking the sensation of pain from around the belly button down into the legs.  

What is a natural birth or unmedicated birth?

A “natural” or “unmedicated” birth can mean different things to different people. Some people refer to a natural birth as a birth that is not induced (not started with medication such as pitocin) or assisted with similar medicines. Other people refer to these births to mean without the use of forceps, vacuum or cesarean section.  While others refer to natural or unmedicated as in no pain medications are used (epidural and IV pain medications). For the purposes of this information, we will refer to it as no pain medications used. 

Pros of an Epidural

• Less or no pain: Epidurals help women no longer feel uterine contractions or the discomfort associated with the descent of the baby’s head into the pelvis and, eventually, the vagina during delivery. For many women, this helps them to relax more fully during labor and delivery without feeling stressed about pain. 
• Medication doesn’t go to the baby: The medicine in an epidural goes directly into the space in your back where the nerves involved in pain associated with contractions and delivery are numbed. The medication does not go through your bloodstream and into the baby’s bloodstream like IV pain medications do. 
• Relative safety: Although any procedure or medication carries some risk, epidurals are the most common form of pain relief for women in the U.S. who are in labor. They are usually placed by an anesthesiologist who has special training in pain management. The anesthesiologist reviews all risks and benefits and explains the procedure in detail before obtaining your consent to do the procedure. 
• Comfort with possible repairs: After delivery, it is relatively common for women to have a tear or laceration that may need to be repaired. Having an epidural that was already being used for labor and delivery, can help with keeping women comfortable during this repair stage. 
• Full awareness during labor and delivery: With an epidural, the pain medication goes to the nerves and helps to block any discomfort. The medicine does not dull your senses or make you feel “groggy” like some IV pain medications can do. This allows you to be fully, and mentally present during the labor and delivery. 

Cons of an Epidural

• Some risks: Although epidurals are considered routine procedures and are typically without complications, all procedures, including epidurals, have some risks. Some of the more common risks include low blood pressure, nausea, and headaches. You can talk with your anesthesiologist or the person administering the epidural, to learn more about how the risks and benefits relate to you individually. 
• Needs to be decided before delivery: For an epidural to be safely placed, a woman must be able to hold relatively still while the procedure is done. For this reason, it can be challenging to place the epidural if a woman decides that she wants one placed when delivery is imminent or if she is in significant pain. 
• Challenges with pushing: Some women struggle with feeling their contractions when they have an epidural and may find pushing more challenging. This is usually not a significant issue as your healthcare team can tell when a contraction is building and instruct you to push. 
• Sensation changes: Not everyone likes how their body feels with an epidural. It can feel odd to have your pelvis and legs numb. It can also take a while for the numbness to wear off even after the epidural is discontinued fully. 
• Possible need for a catheter: You cannot walk while your epidural is in place, so urinary catheters are often placed temporarily. 
• Inability to walk: You cannot walk when you have an epidural, so you are more limited in the movement you can do during labor and delivery. 
• All of the discomfort may not go away: Sometimes, women who have an epidural won’t experience complete relief of discomfort, or the pressure sensation may still feel intense. Although this happens to some women, most women who receive epidurals are satisfied with the pain relief. 

What does unmedicated labor feel like?

It is normal to feel your uterus contract during labor. It may feel like a menstrual cramp, an ache, or a wave of intensity in your abdomen and pelvis. Some women experience this as pressure, while others experience discomfort. The pressure, ache, or discomfort comes and goes as the contractions come and go. Although the time during the contractions may be intense, most women can relax between the contractions. They usually last between 30-90 seconds and get closer together and more intense as labor progresses. 

Pros of an Unmedicated labor

• Movement: You are able to change positions, walk, squats/lunges, use the restroom as needed, etc. Movement is a great help in relieving the discomfort/pain of labor
• Less tubes: there are less cords and tubes connected to you throughout the labor process as a lot of those are related to having an epidural (urinary catheter, BP cuff, epidural catheter, etc.)
• Pushing effectively: Pushing is often easier or more effective when you can feel your pelvis and vulva area. These sensations guide you and support more efficient and effective pushing efforts
• Natural hormone release: You have the benefit of feeling all the endorphins from labor. These hormones help greatly with pain relief. After the birth these will make you feel on top of the world and support bonding with your newborn. 
• No Risks: When you are not medicated and do not have an epidural, there are no risks or concerns for you or baby related to your pain relief choices.

Cons of an Unmedicated labor

• Pain or discomfort: You will have feeling for the duration of the contraction and you will be able to feel the intensity as it shifts. Pressure changes will also be felt as your baby gets closer to birth.
• Discomfort with possible repairs: Given that you have not had any medication for pain, you will have full feeling in your pelvis and vulva area. A medication called lidocaine will be used to numb the area being repaired. Your provider may also use a more in depth numbing process depending on the extent of your tear as needed. 

During labor or delivery, circumstances may change unexpectedly where an operative vaginal delivery (forceps or vacuum) or cesarean section is recommended. Your care provider will discuss pain management options at that time. 

Think about what you want for your labor and birth and what feels important to you.  If you want more information about pain management options, your Certified Nurse Midwife, OBGYN, labor and delivery nurses, and/or anesthesiologists can talk to you about potential risks, benefits, and options. 

I’m still unsure if I want an epidural. Are there any other options besides having an unmedicated birth vs. having an epidural? 

Yes, for more information, read our blog about additional labor pain relief options.

Lastly, know that whatever you decide, whether to have an unmedicated birth or to use some form of pain management, we are here to support you. We believe in shared decision-making and honor your right to choose what is best for you and your body.