As you and baby get closer to birth day, you’re probably finalizing your birth plan. And if you’re reading this, chances are there’s at least one big decision you’re still trying to make: Will you plan for an unmedicated birth, which is often referred to as a “natural birth”? Or will you plan to get an epidural?

Having a plan for how you’ll manage pain during labor and delivery on the big day is important. It helps you prepare for the experience, and it will also help your labor and delivery team honor your childbirth wishes as much as possible.

In this piece, we’ll help you understand:

  • What a natural birth is (and isn’t) and what an epidural is
  • The potential pros and cons of a natural birth and an epidural
  • When a natural birth or an epidural birth might make sense
  • Other pain management options you may not know about

Epidural vs. natural birth methods: What’s the difference?

What is natural childbirth?

To be clear, there’s no such thing as an “unnatural birth”. Everyone’s birth experience will be unique. So when people refer to “natural childbirth”, they’re often referring specifically to giving birth with the use of little-to-no pain medication.

Natural birth can also mean taking a wellness-based approach to the childbirth process. Generally, this means that labor starts on its own, rather than inducing it, and letting the process run its course with minimal intervention. Simply put, natural birth is about giving birth at your body’s pace.

What is an epidural?

An epidural is an injection of anesthesia in your lower back that numbs your nerves from the waist down – which is why it’s sometimes called an epidural block. Epidurals are one of the most common pain medications used during childbirth.

The epidural anesthetic is usually delivered through a catheter in a continuous flow or a repeatable dose, in order to keep your comfort consistent throughout labor. But before the epidural is placed, an anesthesiologist numbs the area. So you may feel that first prick, but the epidural placement usually doesn’t hurt.

When you’re in labor, you can get an epidural at almost any time you choose. Many people choose to get an epidural during the first stage of labor once their cervix has dilated to around 4-5 centimeters – this is right before active labor typically begins. If you’re eight or more centimeters dilated, it’s likely that your care team won’t have enough time to place the epidural.

The pros and cons of natural births

Benefits of natural birth

One of the main benefits of giving birth without an epidural – or with minimal medications in general – is potentially fewer side effects for both you and your baby.

Other benefits of natural birth can include:

  • A strong feeling of control, empowerment and accomplishment – There’s no right or wrong way to give birth, and some individuals take personal satisfaction in handling their pain head-on. Medication dulls or numbs some sensations, so going without may make you feel more connected to the experience overall.
  • The ability to change birthing positions – Since pain medications help dull painful sensations, many people find they’re able to move around more freely when they avoid them. For example, if a certain position is uncomfortable, you’ll know it and be able to adjust until you find a better one. Changing positions can also help your labor progress by helping the baby move into a good position for your pelvis.
  • The potential for a quicker labor, delivery and recovery – For some people, a natural birth may go more quickly. While it depends on several different factors, like how relaxed you may be, in some cases medications can interfere with contractions and prolong labor.

Potential risks of natural birth

The biggest drawback of a natural or unmedicated birth is, of course, laboring and delivering without the help of pain medication. Every birth progresses at its own pace, and every person will experience both the beauty and the pain in their own way.

Other potential issues can include:

  • A longer labor – For some people, being too anxious, stressed or just plain tired can make labor take longer to progress. And sometimes your baby’s positioning can add more time and discomfort to your labor.
  • The pain could take away from the overall birth experience – As magical as childbirth is, pain is powerful. If your labor pains are particularly strong, they may keep you from focusing on the moment in the way that you want.
  • You may end up needing medication anyway – In the event of a complication, like the need for an unplanned C-section, pain medication will be necessary to safely perform the surgery.

It’s also important to note that a natural birth may not be possible for everyone. If you have certain medical conditions or your pregnancy has been deemed high risk, your care team may recommend against a natural birth in order to ensure the safety of you and your baby.

The pros and cons of epidurals

Benefits of an epidural birth

The biggest benefit of an epidural is undoubtedly pain relief during labor and through delivery. After the 10 to 20 minutes needed for an epidural to take effect, many individuals find that an epidural provides them with an easier, less stressful birth experience.

Other benefits of giving birth with an epidural can include:

  • Flexible pain relief – If you use an epidural for labor, the dosage and resulting numbness can be increased or decreased depending on how much relief you need. This can include being able to control your medication pump with the push of a button.
  • Non-drowsy pain relief – Many individuals choose an epidural because it relieves their pain and relaxes them, while still allowing them to stay awake and alert during labor and delivery.
  • A backup plan – If you’ve planned for a natural birth, but the pain gets to be too much, you can still choose to get an epidural or other pain medication if you’re giving birth at a hospital-based birth center. If you’ve chosen a freestanding birth center for your delivery, epidurals are typically not an option. So, you would need to be transferred to a local hospital if you change your mind.

Risks of epidurals

Epidurals, like any pain medication, come with side effects – which is what most people worry about when they’re making their decision. Epidurals are generally considered safe and complications are uncommon, but some individuals may experience things like headaches or nausea.

Other potential issues with having an epidural can include:

  • It may not be possible – If you have certain medical conditions, your labor progresses too quickly, or an anesthesiologist isn’t available, you simply may not be able to get an epidural – though other options like nitrous oxide may still be available.
  • Limited mobility – Since an epidural numbs your lower body, you won’t be able to move as freely to change positions or safely stand up until after the medication wears off. Sometimes this causes labor to slow down.
  • Difficulty pushing and potentially prolonged labor – For some individuals, the epidural’s strong impact can make it harder to feel contractions and push during delivery. Also, if the baby is in an abnormal position relative to the pelvis, an epidural may make it more challenging for the baby to move out of this position. This may mean needing intervention to help labor progress.
  • Lowered blood pressure – Sometimes an epidural can cause a drop in blood pressure during labor, which may lower your baby’s heartrate. However, since this possible side effect is well understood, your care team will take steps to manage blood flow to your baby in order to offset it.

Can I be too far along in labor to receive an epidural?

Yes. If you arrive at the hospital and you’re already dilated to eight or more centimeters, then you may be too far along to receive an epidural. In these cases, we make every effort to get an epidural placed in time to provide relief, but we just might not have time before baby comes.

The good news is that you’ve made good progress! And your health care team will work with you to determine what options you have. When you’re at the end of dilation, you’re often near the pushing stage and will soon get to meet your baby.

How to choose between giving birth naturally and having an epidural (or something in between)

Is your pregnancy considered high risk?

Natural childbirth may not be the best option if you have a high-risk pregnancy.

For example, you may be deemed a high-risk or complicated pregnancy if you’re expecting twins, or if you have certain health conditions like high blood pressure or diabetes. In these cases, your care team may recommend a medical intervention in order to make sure your birth experience is as safe as possible.

Do you know all your pain management options?

Natural birth and an epidural birth aren’t your only pain management options. There are a variety of techniques and medications you’ll likely be able to choose from depending on where you decide to give birth.

For example, when it comes to non-medication pain management tools, you may have techniques that you learned during pregnancy, such as using a birthing ball, and focused breathing or visualization, which may help take your mind off of your pain.

There are also a number of therapeutic options that may be especially helpful for reducing your pain, such as massage or aromatherapy to help you relax during labor. A water birth or hydrotherapy, and even acupuncture, can also be options. Just as a massage or a warm bath may ease your mind and body in everyday life, many women find these kinds of techniques to be really helpful during childbirth.

And when it comes to pain medications, the world-renowned epidural isn’t your only option. Some medications can also provide a numbing effect, while others can take the edge off your pain and help you relax. Other common pain medications used during labor include nitrous oxide and analgesics.

You can also combine certain tools and techniques. Some aren’t compatible, such as pain medications and water birth. But massage and aromatherapy, for example, are unlikely to interfere with anything.

What kind of birth experience are you hoping to have?

Do you feel empowered by the thought of giving birth naturally? Do you think pain medication may help you stay relaxed and focused? Or, do you think that you want to try for an unmedicated, natural birth but have options if things don’t go exactly as you hoped?

As long as you communicate your wishes with your care team in advance, you’ll likely be able to have any of the above.

As you finalize your birth wishes, talk to your family doctor, midwife or OB-GYN about what your ideal birth experience looks like. They can help answer any questions you may have, as well as help you determine any next steps you should take.

For example, doctors and midwives can all manage natural births, but they can have different focus areas and specialties. So one may refer you to the other to help you achieve your ideal birth scenario. You could also choose to include a doula as part of your care team to support you with non-medical pain management techniques and advocate for any changes you want during labor.

When the big day comes and more questions about your options bubble up, your doctor or midwife, labor and delivery nurses, anesthesiologist, and other members of your care team can help you determine what’s right for you.

Plus, if you choose a birth venue with flexible pain management options, like a hospital-based birth center, you’ll be able to start natural and adjust your plan as needed during the first stage of labor.

Medicated or unmedicated birth: Which is right for you?

There is no right or wrong way to give birth. All that matters is the health and safety of you and your baby. So, how you’ll manage pain during childbirth is up to you – and your care team will be there every step of the way.

Your prenatal care team can help answer any questions you have about unmedicated birth, an epidural birth or other pain management options before the big day. And when it comes time to decide where you’ll give birth, make sure you choose a hospital that can provide the options you’re looking for and the flexibility you might need.