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Epidural or Drug-Free Birth?

pregnant woman in hospital gown

Blend Images/Veer

Story of Jennifer L.W. Fink

Early in their pregnancy, my brother and sister-in-law announced their birth plan. My sister-in-law summed it up for me with one word: "Drugs!" My brother shrugged. "She has a low pain tolerance," he said.

Before she experienced a single contraction, my brother's wife decided to use pain medication during labor, a choice made by thousands of American couples each day. And why not? With childbirth widely acknowledged as one of the most intensely painful experiences known to humankind, why would someone choose to give birth without drugs? How about because it's more comfortable! As counterintuitive as it sounds, my drug-free third labor was far more comfortable -- and empowering -- than my epidural-assisted first labor, or my narcotics-assisted second birth.

Natural childbirth is definitely not common in our society. C-sections, inductions, and epidurals are closer to the norm today, and many women consider any labor that ends in a vaginal delivery "natural childbirth." The idea of a woman laboring undisturbed, without drugs, seems almost quaint -- if not downright backward -- to a lot of women.

My first birth was fairly typical. I spent most of my labor just wanting it to be over. It hurt. I wanted the pain to stop. I certainly didn't want it to get worse. When my doctor suggested breaking my water 12 hours into my labor to "get things going," I agreed. Anything to speed it up!

Learning a Lesson

Although I'm a registered nurse, I didn't realize then how much one intervention would affect the course of my entire labor. But I knew that breaking my water would make my contractions more intense, so I insisted on an epidural. The cascade of interventions had begun. Soon I had an external fetal monitor around my middle, an epidural in my back, an IV in my left arm, and a blood pressure cuff around my right arm. When the doctor determined that a full bladder was blocking the baby's descent, they inserted a catheter. And when my baby's heart rate dropped while I was pushing, they strapped an oxygen mask to my face and used forceps to pull my son into the world. My back ached for days at the epidural insertion site, my hand was sore from the IV, and I couldn't sit normally for weeks. I didn't feel like myself for almost a month.

Later, I couldn't help but wonder, What if I'd never let the doctor break my water or had the epidural? I started to read books such as The Birth Book by Dr. Sears, and Natural Childbirth the Bradley Way. What I learned made sense to me: When you work with your body instead of fighting it, labor is marvelously efficient. I learned that each intervention has side effects, often leading to more interventions, a fact supported by my own experience.

Labor & Delivery: Epidurals
Labor & Delivery: Epidurals

For my second labor, I decided to surrender to my contractions instead of fighting them. Still, when I arrived at the hospital, I began to doubt my ability to give birth. I considered an epidural. We tried a small dose of IV Nubain instead. The drug made me feel sleepy. I found the hot tub a much more effective form of pain relief. I felt less pain than during my first birth, and while some might say it's because subsequent labors are shorter and therefore less painful, I think the tub played the bigger role. My nurse-midwife monitored me while I labored in the tub, and when I felt the urge to push, she helped me out onto the bed. Five minutes later, our second son was born -- pink, healthy, and happy. I felt 100 percent better than I did after my first birth. Seconds, not weeks, after delivery, I felt like myself again.

Later, I wondered if the Nubain had really been necessary. I realized that in my helpless moment I'd simply wanted someone to do something; maybe I'd needed reassurance more than drugs.

For my third labor, I relied on the support of my midwives and the wisdom of my own body. While my labor was intense, I wouldn't describe it as painful. I spent each contraction relaxing, allowing my body to do its necessary work. Our third son was born shortly after midnight in a peaceful, powerful water birth.

The feeling of triumph I experienced was tremendous. Through my own labor, I brought my son into the world. I gained an appreciation for my body and a sense of personal confidence that persists to this day. I know that deep within me I have the capacity and strength to deal with anything. That's a gift no drug can give.

Birth Stories: Unmedicated Childbirth
Birth Stories: Unmedicated Childbirth

Story of Marisa Cohen

After spending the better part of a year researching a book on childbirth (I interviewed close to 100 women) and listening to moms passionately explain to me why they chose to go through childbirth without any drugs, I absolutely understand why it was the best possible choice for them, and how it made their day of labor an incredible, empowering experience. I sit here in awe of their perseverance and willpower. And I think about everything I went through during my first labor -- the Pitocin and the epidural, the catheter and the blood pressure cuff -- and I realize that while it wasn't quite as beautiful and inspiring a scenario, it worked for me, and if I were to do it all over again, I would still choose a medicated birth.

Mind you, it's not like my preference for a medicated labor is based on nothing. I did experience natural labor for a good six hours with my first daughter's birth. The first couple of hours after my water broke were manageable -- the contractions were mild as my husband and I walked around the corridors of the labor and delivery ward, showing off my new leopard-print slippers to the night-shift nurses and practicing how we were going to tell all our friends the story of my water breaking right after the creme brulee had been cleared.

But by hours three and four, I could not walk. I could hardly breathe. The herculean effort of moving my body even one tiny inch was rewarded by an invisible gremlin twisting a steak knife even deeper into my back. I have dug deep into my psyche and come to the conclusion that for me there was nothing empowering about my stint of natural labor. The only thing I learned about myself was this: I really don't like extreme pain.

And yes, after talking to natural-birth moms, I do acknowledge that my perception of the pain could have been affected by listening to all those stories passed around our culture about the agonies of childbirth. But you know what? It just didn't matter that much to me. Achieving a powerful, organic birth experience was not as high on my list of priorities as having a comfortable delivery, which in my case meant having an epidural.

The thing that really bothers moms like me who opt for medicated births is the idea that this kind of scenario is somehow second-rate. Medicated-birth moms reject the idea that their kind of birth can't be as rewarding as a natural birth. Though we may not experience that rush of triumph that so many natural-birth moms describe, most of us are still pretty blissed out.

Birth Stories: Delivery with an Epidural
Birth Stories: Delivery with an Epidural

Back to my story. After I spent a very unpleasant hour or so on Stadol, my doctor finally agreed to page the anesthesiologist, who gave me the epidural. After one or two more contractions, the pain was gone. It was almost dawn, and the sun coming up outside my window was the perfect metaphor for the way my mood changed from darkness to delight. Before the epidural, I couldn't even look at my husband, Jeremy. As soon as I relaxed, so did he. Now I was able to lie back peacefully and hold his hand while he read me the recap of last night's Mets game. I was able to think about the baby and shake off the miserable persona I had unwillingly taken on. I reverted to my happy-go-lucky self -- and that was the person who I thought should greet my baby when she entered the world.

The price I paid for that transformation was that in the dozen more hours that I labored, I was subjected to a steady stream of interventions: Pitocin, an internal fetal monitor, a catheter. It's true that these interventions made me a prisoner of my hospital bed, but hey, I wasn't going anywhere anyway. I had the newspaper, my husband, a TV, a telephone. I was perfectly happy to stay put. And then, just after 7 p.m., I easily gave birth to a healthy little girl, without having to suffer through any more agonizing pain.

Do What You're More Comfortable With

The whole crazy debate comes down to this: we are all becoming moms, and if a mother-to-be will feel more triumphant and healthy and ready to tackle motherhood after a natural birth, then she should absolutely go forward with a natural birth. But if she feels more secure, comfortable, and ready to be a parent after a medicated hospital birth, she should proudly and guiltlessly do it.

Marisa Cohen is the author of Deliver This! Make the Childbirth Choice That's Right for You -- No Matter What Everyone Else Thinks (Seal Press).

Originally published in American Baby magazine, May 2007.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.