Can You Give Birth Without an Epidural?

"The hardest part was definitely transition, the rest was strangely easy, even fun!"

Can You Give Birth Without an Epidural?

When a woman gives birth it can take hours, sometimes even days. Knowing that labour and birth are painful can lead people to make the assumption that a woman will be in unbearable pain for the duration of that period. It’s no wonder women are terrified of birth, nor that so many well meaning friends and family push epidurals.

“Just get the epidural and be done with it” They say sagely,

OR

“There’s no medal for doing it without drugs” said with a knowing smile and a pat on the back.

And it’s true! There’s absolutely nothing wrong with a woman who decides she would like an epidural. The problem is that we perceive birth to be unmanageable without one. Perhaps if we heard more from women who have done it without, and how they managed, it would be less daunting to women who are anxiously awaiting their day, wanting a drug free birth, but not sure if they can do it. 

The problem with epidurals is not that women want to use them, it’s that they can cause complications. Although it is commonly believed that they are a safe way to make labour into a pleasant experience, this is often not the case. Marden Wagner states in his highly respected essay Technology in Birth: First Do No Harm:

”Twenty-three percent, or nearly one in four women, given an epidural block will develop a complication. One undesirable complication is death—epidural block for relief of normal labor pain results in a three times higher mortality rate for the woman than labor without epidural block. One out of every 500 epidural blocks results in temporary neurological problems, such as paralysis in the woman; and in one out of every half-million epidural blocks, this neurological damage to the woman is permanent.”

The complications highlighted here are only a portion of what he wrote though. To read more you can go here.

The truth is that women gave birth quite well without pain relief for thousands of years. There were undoubtedly other other risks during those times, but the concept of modern birth in a hospital is safety, and with so many women experiencing complications from epidurals, we have to question whether birth can be perceived as safe, when women routinely exchange pain for epidurals. After all, the pain of birth is not actually dangerous to physical wellbeing.

There are a number of techniques women can use to help ease the intensity of labour and birth. These include, but are by no means limited to:

  • Hot water bottles or heat packs
  • Meditation techniques that are specifically tailored to labour and birth
  • Water birth
  • Moving freely rather than labouring on a bed (walking, swaying, hip rotations etc)
  • Harnessing the hormones (dimmed lighting, privacy, proper hydration and nutrition)
  • Avoiding induction or augmentation unless it’s absolutely necessary
  • Hiring a doula and surrounding yourself with supportive, non confrontational people

We spend a long time anticipating labour, and women approach it with a nervous sense of excitement. For some women their nerves turn to surprise when  things are far easier than they anticipated. Some women report having painless labours, others talk about enjoying labour,

Annie B: I hardly knew I was in labour until I felt the urge to push. I’ve had two painless labours so far.

Renee S: I had so many plans ready to help me manage labour, and I most definitely hadn’t written off the epidural as one of them. In the end my labour was pretty much painless, I felt the tightening and stretching but no pain. The worst part was crowning, and that didn’t even last five minutes.

These stories are on the rare side of course, however many women speak about how they enjoyed labour for many hours before they ever considered using pain relief.

Tegan S: I really overestimated the pain I would feel during labour. I was surprised by just how easy it was. I walked and talked cheerfully until I was 8.5cm dilated. Then I decided that I wasn’t having fun anymore, and I wanted an epidural. By the time the anaesthetist arrived to administer it I was holding my baby. Labour was easy, transition was hard, but it was super short.

Allana W: I laboured easily for the best part of eighteen hours. I walked around my house, danced to music, swayed, and rocked my hips, and squatted. I thought I must have only been in very early labour because it was so easy. After my waters broke the pain was very intense. I felt my baby move down, and then the urge to push came over me. I don’t know how long I pushed for but it wasn’t very long. The hardest part was definitely transition, the rest was strangely easy, even fun!

Induction is well known to increase the pain of labour, and women who have both an induction and a spontaneous birth are often surprised by how different they are. Induction of labour using synthetic hormones actually intensifies the experience. There are a couple of reasons for this.

  1. Induction blocks the body’s own pain management hormones, oxytocin, and endorphin.
  2. Induction creates intense, and unnaturally strong contractions, that are ironically, less effective than the body’s own natural contractions.

According to Dr John Gianopoulos, M.D., professor and chairman of the Department of Obstetrics and Gynaecology at Loyola University Health System, in Maywood, Illinois,

“Induced labor tends to be more painful than natural labor.”

He then goes on to say

“It initiates strong contractions much sooner, while natural labor begins over a period of days and the cervix tends to be soft and open when active labor begins.” Induced contractions also come closer together and with more consistency; in natural labor they can vary in length or strength, letting a woman rest in between”

In his article The Tree and the Fruit: Routine versus Selective Strategies in Postmaturity, the world renowned Dr Michel Odent discusses how the routine induction of labour increases risks, and frequently begins The Cascade of Interventions, and how induction using synthetic hormones is actually a risk that needs to be balanced carefully against the risks of simply watching and waiting for labour to begin.

Fatima A: My first labour was pretty easy, it was hard work at the end, but I felt so amazing afterwards, it was all worthwhile. My second was induced because I got quite sick at the end. I was really shocked by the induction. It was wave after wave, one on top of the other. I couldn’t do that without an epidural, but my third was born easily, without any epidural.

Eliza A: My first baby was induced and it was the most awful experience of my life. When I went into labour with my second baby spontaneously I didn’t think it could possibly have been the real macaw. We almost didn’t make it to the hospital in time because I kept waiting for it to get bad like the induction. There’s no way I’d ever agree to being induced again unless there was a serious reason for it.

Mariah P: The doctor I had for my first two pregnancies said I had to be induced at 41w. With my first baby I ended up having a caesarean because he became distressed after the epidural. Then she induced my second baby as well, and it was exactly the same. Horrible! I hired an independent midwife and had a homebirth with my third baby. I went into labour at 41w exactly and my labour was only nine hours from start to finish. I worked hard and I enjoyed it! My first doctor didn’t explain that there was risks to induction, she made it seem like being pregnant at 41w was the most dangerous thing I could ever do. My midwife gave me information about risks and benefits and the doctor she worked with supported my decision to wait for labour. My birth experiences were like night and day, totally different. 

Women know that birth is hard work, they expect it. No one ever thinks it will be like some kind of Summer picnic, but at the same time it’s impossible to predict how it will be, and how you will manage. That is probably what makes so many people push epidurals! With an epidural you know that whatever happens, it won’t hurt (assuming the epidural works of course). Interestingly, women who don’t have easy or enjoyable labours often talk about how amazing the experience was, and how they felt afterwards.

Penny M: My labour was the hardest thing I’ve ever done. I was shocked by how hard it was, but when my baby was born I felt like I could climb a mountain. I’ve never felt any feelings that powerful. I didn’t feel anything like that after my next baby came and I used an epidural, I actually felt like I had a weird kind of hangover. No way will I have another epidural.

Persephone S: I was in labour for days. It wasn’t the pain that got to me in the end, it was the tiredness! I just wanted to sleep but I couldn’t. When it was time to push I was suddenly wide awake, and when I finally gave birth to my daughter I felt like I’d climbed Mt Everest. Birth was challenging like nothing I’ve ever done, but it was also the most important thing I ever did. My daughter was well and truly worth every moment of pain and exhaust. 

Image of spinal cord where an epidural is placed
Epidural Space.
License: Creative Commons CC0.

Jade A: Birth was the hardest thing I ever did, but I did it! And I felt like a million dollars afterwards. Despite the fact that it hurt so much, and went on for so long, I’m still looking forward to doing it again in a couple of weeks. I’ve definitely had moments of worry about it, but for the most part I’m really excited!

Min-Jun K: I wanted to have an epidural so that I didn’t feel any pain but it happened too fast. My baby’s birth was less than two hours and hurt a lot, but when I looked into his eyes and heard him gurgling at me for milk I knew I would have done it three times more just to hold him in that instant.

Birth doesn’t have to be horrendous, women don’t need to be anxious about it. Epidurals are available, and they’re a valid choice that should be available to women who really feel that they can’t do without. For women who want to give birth without chemical pain relief but are nervous, they should know that birth can be easy, it, can be enjoyable, it can be hard, or intense, but you CAN do it. There’s no shame in epidurals, but there can be disappointment later on if your plan was to do it without. So if you’d like to give it a go without drugs, talk to women who did it, not women who tell you that you can’t, make a solid plan and ensure that your support team understands what is needed of them. Good luck! 

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