The Pros and Cons of Epidurals vs. 'Natural Births'

Trying to weigh the benefits of “natural birth” against local anesthesia? Read about the pros and cons of epidurals, as well as two real-life stories of different deliveries.

According to the Centers for Disease Control and Prevention (CDC), most people receive an epidural or spinal anesthesia to relieve labor pain. Others opt for a "natural birth" with no drugs and minimal interventions. (Note: The term "natural birth" is problematic because all births are natural processes, regardless of whether the mother received pain medication or not. A better term would be "drug-free birth or "unmedicated birth.")

Understanding the pros and cons of epidurals and "natural births" (which simply means a birth without pain medication) can help you decide which one is best for you. Keep reading to learn more, and hear stories from two real-life women who've given birth themselves.

natural birth vs epidural pros cons

The Pros and Cons of Epidurals

Epidurals and spinal anesthesia can relieve the worst labor pains for pregnant people. Here are some other benefits and drawbacks.

Benefits of epidurals

  • Pain relief during labor, which begins after about 10-20 minutes
  • Epidural can be tailored to the parent's preference and increased or decreased as needed
  • Allows the parent-to-be to stay relaxed, alert, and stress-free
  • If you change your mind about your "natural birth" plan during labor, you can usually still get an epidural
  • It's generally safe and effective
  • For some people, an epidural can actually help labor progress by allowing muscles to relax

Drawbacks of epidurals

  • Some studies link epidurals with a greater chance of needing risky interventions during delivery (forceps and vacuum extraction, emergency C-section, etc.)
  • Side effects can include low blood pressure, a headache, nausea, dizziness, and a backache
  • Potential prolonging of the delivery process
  • Pushing may be more difficult, which is associated with an increased risk of perineal tearing
  • Lower body becomes numb, which limits movement during labor
  • Potential need for a urinary catheter
  • Infection or spinal injury from epidural needle (although this is extremely rare)

"Natural Birth" Pros and Cons

"Natural births" without pain medication or interventions can make some people feel empowered, but you have to consider many factors before deciding on a drug-free birth. Here are some of the pros and cons.

Benefits of "natural birth"

  • May have a faster recovery after birth
  • Potential for less vaginal tearing
  • Some people may have a shorter pushing time
  • Ability to change birthing positions, including walking around
  • Decreased risk of needing risky interventions
  • Some people feel a sense of accomplishment and fulfillment
  • Avoid side effects associated with epidurals

Drawbacks of "natural birth"

  • Must manage pain without medical assistance
  • Physical pain might detract from the experience of childbirth
  • "Natural birth" may not be possible for people with high-risk pregnancies
  • Due to medical reasons, the pregnant person may need interventions or drugs anyway
  • Potential for prolonged labor if the birthing person is tired, anxious, or stressed
  • In the case of "natural home births," the birthing person and/ or baby may not have access to medical equipment in case of emergency

Real-Life Birth Story: "Natural Birth" Without Epidural

Jennifer L.W. Fink's story: 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 weigh the pros and cons of giving birth without drugs? How about because "natural birth" is 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 About Medicated Birth

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 needle 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 William Sears MD FRCP, and Natural Childbirth the Bradley Way by Susan McCutcheon. 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.

Deciding Against an Epidural

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.

Real-Life Birth Story: Getting an Epidural

Marisa Cohen's story: 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 crème brûlée 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 childbirth 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.

Labor Didn't Hurt After the Epidural

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, and 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.

The Bottom Line

The whole debate comes down to this: We are all becoming parents, and if someone will feel more triumphant and healthy and ready to tackle motherhood after a "natural birth," then they should absolutely go forward with a "natural birth." But if that individual feels more secure, comfortable, and ready to be a parent after a medicated hospital birth, they should also proudly and guiltlessly do it. We're all different, we all parent differently, and those differences can start as early as at birth, so do your best to make a plan for what's best for you.

Updated by Nicole Harris
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