Making the decision whether or not to get an epidural is important. Here I discuss the pros and cons of getting an epidural as well as those of opting for an unmedicated birth to help you make an educated decision.
This post may contain affiliate links. Click here to read my full disclosure policy. *I am not a medical professional and this post should not be taken as medical advice. I’m sharing my real experiences and opinions backed by cited research.
Weighing the Decision to Get an Epidural
Most of the studies I’ve found say that roughly two thirds (~60%) of women who give birth vaginally opt for an epidural.1
Perhaps you are wondering “why would anyone choose not to get an epidural!?!”
An epidural can provide great pain relief during childbirth, but it is not entirely without risks.
Bringing your baby into the world comes with a lot of decisions and the choice whether or not to get an epidural can be a difficult one.
Education is key. When I was pregnant as a first time mom, I spent a long time doing research, talking with my provider, and discussing the options with friends and family.
For myself, it helped a lot to create a list of pros and cons of each to be able to weigh all of the information.
This list of pros and cons can help you make an educated decision that will be best for you, your partner, and your baby.
Changing Your Mind
Birth can be unpredictable and it’s difficult to know exactly what it will be like without experiencing it for yourself.
In addition, no two births are the same. While it is wise to create a plan and prepare for birth ahead of time, it’s also necessary to be flexible.
Being educated about all of your options is important in case things do not go as planned.
It’s totally fine to prepare for an unmedicated birth and then opt for an epidural or vice versa.
Changing your mind is not a sign of weakness, but a sign of strength, education, and flexibility.
Some women may plan for an epidural, but are not be able to get one due to timing of delivery or other health conditions so being educated about all of your options can help you have a positive experience regardless.
What are the pros of getting an epidural?
1. Powerful pain relief
The most obvious pro of getting an epidural is that it provides pain relief.
It’s no secret that natural childbirth is described as painful by most women (although it doesn’t always have to be).
While there are a couple of other options for pain relief during labor, an epidural is by far the most effective option and the most widely used.
Pain relief is typically felt within 10-20 minutes of epidural placement and most women report feeling little to no pain when delivering with an epidural.3
2. Provides the ability to rest
Giving birth is a lot of work and can be totally exhausting.
The average labor for first time moms is 12-24 hours, but can last up to 36 hours or more.4
Hard work over such a long period of time can deplete you of your energy.
Unless you schedule an induction or C-section, you won’t know exactly when you’ll go into labor.
Chances are, you’ll labor during some part of the night when you would normally be sleeping which can add to the exhaustion.
An epidural can provide much needed rest to the mother and her support team.
3. Requires less preparation
If you want to have a positive unmedicated birth experience, you’ll need to do some mental and physical preparation.
I wouldn’t recommend trying to avoid an epidural without preparing beforehand.
Relying on getting an epidural as your pain relief method does not require as much work ahead of time like practicing relaxation or hypnobirthing for example.
4. Can help you relax
When we experience pain, we tend to tense up.
Bracing yourself before each contraction and tensing as it comes on can actually slow down labor.
You’re essentially working against yourself, because contractions are opening up your body, but tension tries to close it up.
For some women, once they get an epidural, they find that labor speeds up, because their bodies are able to calm down and allow their contractions to open the cervix.
However, it is also common for an epidural to slow down labor for a variety of other reasons I’ll mention below.
5. You can control the dose
Another great benefit of an epidural is that you can often get more of it if needed.
The epidural is a port into your spine with pain medicine flowing in and having an epidural allows you to get more pain medicine into your system as the previous dose wears off.
Sometimes you can get what is called a walking epidural or combination epidural which is a lower dose of anesthesia that can allow you to move a bit more freely while still getting some relief.5
6. Allows you to stay awake if you need a C-section
Things don’t always go as planned and you may end up needing a c-section.
An epidural is a miracle for mamas during a c-section because it gives you more localized anesthesia that will numb your lower body while allowing you to be awake during the procedure.
If you already have an epidural and then a c-section becomes necessary, it will be much easier to go right into surgery.
What are the cons of getting an epidural?
1. Numbness and limited mobility
An epidural aims to numb the lower body to block the sensation of pain.
The numbness can make some moms feel like they’ve lost control or they feel disconnected to the birthing process.
You are generally not able to walk around after receiving an epidural due to the loss of sensation that comes with it.
An article in Midwifery Today talks about how the “severe restriction in mobility” caused by an epidural is related to a negative birth experience.9
Being able to move around is extremely helpful for getting the baby to engage in the pelvis and move down the birth canal.
Not being able to move around can slow down labor.
2. You’ll need a catheter
Because of the loss of sensation that comes with an epidural, it is standard procedure to place a urinary catheter.
You won’t be able to get up and use the restroom and you probably won’t even be able to tell if you need to.6
A catheter makes it easier for the hospital staff to keep everything sanitary so they will place one when you get an epidural.
3. Can lower your blood pressure
Your blood pressure may drop after an epidural and you’ll need to have it checked often.
If your blood pressure lowers, you’ll be given medication to raise it.
This also requires you to have an IV so you can get medication quickly if needed.
Women who have low blood pressure issues may not be able to get an epidural due to the added risk.6
4. Coached pushing and pushing on your back
Because you will be numbed, you’ll be directed to push on your back.
Your doctor or midwife will likely count for you as you push and will tell you when and how to push.
For some women, pushing on their back feels like the most comfortable position.
However, there are a variety of pushing positions that make it easier for the baby to work their way through the birth canal since being on your back tends to fight against gravity and can cause the baby to face the wrong direction.
Birthing in an upright position can allow gravity to work in your favor.
Pushing is most effective during a contraction, but if you’re not able to feel your contractions, you’ll need help with knowing when to push.
Coached pushing can be motivating for some, but for a lot of women it is exhausting, feels unnatural, and can cause you to push before your body is ready.
Pushing when your body is not ready to push can increase the risk of tearing.
5. Reduced oxytocin
Oxytocin, also known as the love hormone, is the main hormone released during labor and it causes contractions.
The drugs used in an epidural can block the release of oxytocin causing labor to slow down.
Pitocin is the synthetic form or oxytocin and is often given to induce labor.
You may be given Pitocin after getting an epidural in order to keep contractions going strong.
Lowered oxytocin can decrease the Fetal Ejection Reflex as well as reduce the ecstatic feeling after birth.9
6. Slower recovery and bonding with baby
If you give birth without an epidural, you can get up and walk right away.
Conversely, with an epidural, you’ll have to wait until the anesthesia wears off before you’re able to get up.
There is anecdotal evidence that suggests that the anesthesia can affect mom and baby’s ability to bond and breastfeed after birth.
Some women report that their baby is extra drowsy due to the anesthesia crossing the placenta.
However, other research has found that this is not the case.
7. Medical Risks
In addition to the cons listed above, there are always risk associated with the use of anesthesia as well as injections into the spine.7
I know women who have had severe spinal headaches after birth due to complications from having a needle in their spine.
Some women report feeling pain at the epidural site or lasting headaches for some time after giving birth.
The journal Midwifery Today cites the risk of a fentanyl itch, a rash that can develop, as well as the likelihood of severe back pain, soreness at injection site, and headaches.9
There is also always some, though small, infection risk when you are dealing with needles.
Sometimes women have a fear of needles that discourages them from getting an epidural.
In addition, there can be medical conditions that prevent women from getting an epidural, even if they want one.
8. The “Cascade of Interventions”
There is a theory that the more interventions you have, the more you’ll end up needing.
For example, if you get Pitocin to induce labor, then you get an epidural to help with the extra pain, then you end up needing an IV to help with your blood pressure plus continuous fetal monitoring, which makes it so you can’t move around, which slows down labor so you need more Pitocin.
Then you push on your back, but the baby gets stuck since that’s not an optimal position so forceps are needed. And on and on..
While some doctors disagree that one intervention increases the likelihood of other interventions, there is a growing body of research to support the theory of cascade of interventions.8
One study found a significant relationship between an epidural and the need for instrument use during delivery.2
Some women choose to avoid an epidural solely to avoid the cascade of interventions that can come along with it.
What are the pros of unmedicated birth?
1. Ability to move around during labor
An important reason women may opt out of the epidural is being able to move around during labor and delivery.
Changing position frequently during labor helps the baby engage in the pelvis and can relieve pressure you’re experiencing.
For myself, being able to bounce on a birth ball, go to the bathroom, walk around, etc. were a huge part of having a positive birth experience.
Having the ability to move around allows you to use a birthing tub, get counter pressure, and use gravity to your advantage.
Movements like the Miles Circuit, curb walking, bouncing on a birth ball are all ways to help the baby engage in the pelvis during labor.
2. Less likely to need interventions
There are a few extra interventions that always come along with getting an epidural like needing to have an IV and a catheter placed.
If you don’t have an epidural, you’re less likely to need either of those.
According to research, the more interventions you have, the more you are likely to need (cascade of interventions).8
Other interventions, like needing a vacuum or forceps, episiotomy, c-section, etc. are more likely when you have an epidural.
Many women who choose not to get an epidural are often confident in their body’s abilities and the birth process and want to avoid extra intervention.
3. Self directed pushing and less risk of tearing
As you listen to your body and push when you’re ready to push, the walls of your vagina are able to stretch gently. This reduces your risk of tearing.
If you are numb and unable to feel when you need to push, your provider will need to tell you when to push based on monitoring of your contractions.
This makes it difficult to follow your body’s cues and is more likely to cause you to tear as the baby moves through the birth canal.
On the other hand, pushing when unmedicated helps you to feel surges and you are able to follow your body’s cues.
The Fetal Ejection Reflex can even take over and push your baby out without you needing to push. Not all women experience the FER, but some do.
4. Shorter labor
There are several reasons why having an unmedicated birth can shorten labor.
Being able to move around into different positions is a huge way to help labor move along.
Walking, bouncing, swaying, etc. can help your baby engage in your pelvis and will put pressure on the cervix to help it dilate.
Another way an unmedicated birth can be shorter than a medicated one is that a epidural can block the release of oxytocin, which is the hormone that stimulates contractions.
Lastly, pushing in an upright or forward position is more allows the baby to move down the birth canal more naturally and therefore more quickly.
5. Easier bonding with baby
Oxytocin is also the hormone that helps you bond with your baby.
It is released when you make the baby, birth the baby, and feed the baby.
Many women report experiencing a rush of adrenaline and emotion once the baby is born.
This natural ecstatic feeling helps mom and baby bond and feel connected to each other.
It also encourages breastfeeding, which is another important way for mom and baby to connect.
6. Mom and baby are more alert
There is evidence that the medication in an epidural does cross over the placenta and reaches baby.
Both mom and baby can feel groggy, dizzy, and tired when given strong pain medication.
Babies are usually the most alert during the first hour after being born. This is the golden hour where mom and baby are able to bond and baby should eat.
If your baby is groggy from getting medication through their umbilical cord, they may not want to eat or bond.10
Women have reported wanting to avoid an epidural to be able to feel more connected to their bodies and the powerful birth process.
7. Faster Recovery
Since an epidural usually numbs the body, you’re not able to get up and walk around for a while after birth.
Giving birth naturally without medication can actually send you a rush of hormones that help you feel great after giving birth.
You are able to get up and walk around immediately after birth, unless you have other medical reasons for why you need to stay in bed.
Many women who have given birth with and without an epidural say the recovery was much faster after their unmedicated births.
8. Feeling of accomplishment
There are few things in life that are harder, more exhausting, and more exciting that bringing a baby into the world.
Women who give birth unmedicated report a strong feeling accomplishment.
That’s not to say that women who have a medicated birth don’t feel accomplished.
The combination of hormones, adrenaline, and hard work create an ecstatic feeling the moment your baby is born and that can be felt much more readily by those without medication.
Giving birth naturally is exhilarating and some call it euphoric.
It is amazing what our bodies can do and being able to experience all of it is another evidence of that power.
What are the cons of giving birth naturally?
1. It’s exhausting
Giving birth unmedicated is a ton of work and can be totally exhausting.
If your labor goes on for too long you may run out of energy which can slow down labor further.
Your entire body is doing a workout for hours and hours.
2. It hurts
It’s no secret that giving birth is usually a painful process.
That’s why the majority of women opt for an epidural.
If you do not have an epidural, you’ll need to find other ways to deal with the pain.
3. Need more support
Women who give birth without an epidural may want counter pressure, help with a rebozo, massage, etc.
Your partner can provide great support during labor, but you may also want help from a doula.
Hiring a doula can be expensive, although many (including myself) feel they are worth it!
Final thoughts
Getting an epidural is a popular choice and the majority of women choose to get one during labor.
However, if you would like to give birth naturally, there are some excellent methods for dealing with pain during labor.
You can find books, courses, and classes that can teach you how to give birth naturally.
I took an incredible course called “How to Give Birth with Practically No Pain” which helped me to have an unmedicated birth without ever even thinking about getting an epidural.
They offer an awesome free online webinar that will teach you powerful tools to eliminate pain during labor. You can sign up for that webinar here. If you go through the free online webinar, you’ll get $100 off if you decide to purchase the full course!
You can read more about my experience with the course here.
Whatever your decision, the most important thing is that you and your baby are safe.
Choosing to be flexible and choosing to be educated will help you have a positive birth experience.
Sources
- The experience of giving birth with epidural analgesia https://www.sciencedirect.com/science/article/abs/pii/S1871519214000067
- Epidural Analgesia and Severe Perineal Laceration in a Community-based Obstetric Practice https://www.jabfm.org/content/16/1/1.short
- Pregnancy and birth: Epidurals and painkillers for labor pain relief https://www.ncbi.nlm.nih.gov/books/NBK279567/
- Labor & Delivery https://my.clevelandclinic.org/health/articles/9676-labor-delivery
- What is a walking epidural? https://www.verywellfamily.com/walking-epidurals-2752787
- Labor Epidural https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-education/beginnings/preparing-for-labor/at-the-hospital/what-you-should-know-about-a-labor-epidural
- Postpartum headaches after epidural or spinal anesthesia https://journals.lww.com/co-obgyn/Abstract/2021/04000/Postpartum_headaches_after_epidural_or_spinal.6.aspx?context=LatestArticles
- Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235054/
- The Epidural Trip https://d1wqtxts1xzle7.cloudfront.net/51048091/The_epidural_trip_why_are_so_many_women_20161225-24631-1q5srit-with-cover-page-v2.pdf?Expires=1668291129&Signature=TMFcLnz-~Z-13DJHlcPFoTZkiAJuqkwQd6zJrlVlxv27RYj4EzObRwOnYzH7UyjIvLboLJWBV3HO7SgNGybFVCMfVY6Kg9Twgg98jxLLPk9x-ISzsiuGPka6zOTaZTa30xrLyOeeignT1O4r56~gC3DiyFv8K1RZhIKonTcHFnQyvA77PrsQo4W-7Wef6CrerDLJV4XvMq6qpflEam14pE8CxzE1v99ssnAZ-XUSEoHkQ~GKiZNIX3MkPQhcDIXRk9cqW22hI5nZr5PN5heF5mufaTBzqJF-MDE93DOJkoE9k-0VUHghMZVhEV49sfSVoTYxbHFV1cbdeAIYkrZppw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA
- Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin, in response to suckling during the second day postpartum https://pubmed.ncbi.nlm.nih.gov/19210132/
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