'Natural' Birth Without Pain Medication

From start (when to conceive) to finish (how to deliver), pregnancy is full of personal choices. No matter how you deliver — unmedicated, with an epidural or via C-section — you should feel in awe of what you've accomplished and proud of your body.

When it comes to welcoming your baby, if you don't envision giving birth in a hospital setting or you hope to deliver with little to no medications or interventions, an unmedicated birth might be right for you. But what exactly does it mean, and are you a good candidate? Learn about the benefits and the risks of birth without pain medication so you can make an informed decision about your labor and delivery plan.

What is natural birth?

There's no "right" way to welcome a baby into the world, and all types of childbirth are natural. The term "natural birth" has historically been used to refer to vaginal labor and delivery with limited to no medical intervention; it can involve a variety of choices, from the doctor you choose to the pain relief you use.

Here are the most common options usually involved in a unmedicated birth:

• Delivering at a birthing center or at home rather than in a hospital (although you can definitely request to have a drug-free birth in a hospital)
• Working with a doula, midwife or an OB/GYN who has stated a preference for using minimal interventions (talk to your practitioner and ask her if and how often she’s assisted in natural births, or look for OB/GYNs who work at birthing centers)
• Instead of lying on your back in bed, opting for alternative delivery positions including squatting, all fours (hands and knees), kneeling, or leaning against something (a chair or your partner)
• Giving birth in a tub of warm water
• Alternative drug-free methods including hydrotherapy, hypnosis, massage, relaxation techniques, mindfulness meditation, breathing exercises and acupressure
• Delivering baby immediately to your stomach for skin-to-skin contact and breastfeeding instead of taking her away to be assessed and weighed first (although many hospitals now encourage this regardless of how you give birth)
• Avoiding routine IV, labor induction, routine episiotomy (which, fortunately, is rarely used these days anyway), assisted delivery with forceps, vacuum extraction and cesarean section (unless one of these medical interventions is deemed medically necessary)

What are the benefits of a natural birth?

Many moms who opt for a unmedicated birth enjoy knowing exactly what their bodies are capable of without medication. Here are a few other benefits to consider.

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• You'll be able to move. Many women find comfort in the ability to move during labor as a way to cope with pain. Whether it's walking the halls, taking a hot shower or swaying on an exercise ball, you'll have the freedom to move about pretty much as you please with a non-medicated birth — whereas with an epidural you're usually confined to bed.
• Pushing may be more effective. Because you won't receive a pain-relieving drug, you won’t lose any sensation and will be able to move more easily.
• You may be able to walk sooner. You’ll be able to get out of bed and walk around sooner post-birth, since you won’t be numb from the epidural or groggy from medication. In turn, walking will help speed recovery and can help avoid constipation (a common post-birth ailment).

What are the risks of a natural birth?

As with any health-related decision, unmedicated birth carries some risks that should be considered. Here are a few:

• You’ll feel everything. Some women find the pain is much more intense than they anticipated. However, know that you can always let your practitioner know you're planning for a birth without pain medication and ask for an epidural at any time during the process if the pain gets to be too much.
• You may need general anesthesia. If an epidural isn't in place and your baby's heart rate drops, the cord prolapses or another unexpected emergency occurs, you may be put under general anesthesia (or receive medication to make you unconscious) for your safety, since C-section is likely necessary.
• You may be at increased risk of complications. If you're planning for a home birth, know that there's a two- to three-times greater risk of perinatal death when compared with a hospital birth, according to the American College of Obstetricians and Gynecologists (ACOG) — though the risk is still very low (1.3 per 1,000 babies die during labor and delivery during planned home births vs. 0.4 in 1,000 for low-risk hospital deliveries). This is likely because if complications do arise and a mom doesn't live within close driving distance of a hospital, her baby may not get the life-saving treatments he needs quickly enough. However, many hospitals and especially birthing centers are open to natural-birth methods, and they offer access to essential medical interventions in the case that you do need them.

Is natural birth right for you?

Talk to your practitioner about your options and whether a birth without pain medication is safe for you. You're likely a good candidate if you:

• Are expecting one baby
• Are considered full-term, or are at least 37 weeks along in your pregnancy
• Have no chronic health problems and have experienced no pregnancy complications

In some cases, you may be at risk for complications during birth, so your practitioner will want to ensure you receive extra medical attention to be on the safe side. Unmedicated birth is probably not be for you if you:

• Are expecting multiples
• Are preterm, or less than 37 weeks pregnant, when you go into labor
• Are considered overweight or gained too much weight during pregnancy
• Experience other pregnancy complications like gestational diabetes or preeclampsia
• Are a group B strep carrier (you’ll be tested during week 36 of pregnancy); you’ll need IV antibiotics during labor to decrease the risk of neonatal infection
• Have diabetes or gestational diabetes, since you may need an IV and insulin drip during birth
• Have a baby in the breech position when you go into labor — for your safety and your baby’s you will likely require a C-section

How to prepare for a natural birth

The best way to prepare for a unmedicated birth? Get as informed as possible. Here are a few steps you can take before you go into labor:

• Talk to your practitioner. Make sure your care team is on board with your choice.
• Consider hiring a doula. While your OB/GYN’s job is to get your baby delivered in a healthy, safe manner, a doula is the cheerleader-in-chief for you — and you might want the extra support when the pushing gets more intense. During pregnancy, your doula will talk to you about a birth plan, and when you're in labor she'll work hard with you to execute it.
• Get educated. You wouldn’t take an exam without studying, so you shouldn’t try natural birth without reading up on it and talking to friends and family members who have gone through it. Take classes, too, to practice techniques that can be useful in the delivery room.
• Learn about natural pain management techniques. Then practice, practice, practice. In the weeks leading up to your delivery, try a variety of drug-free pain management techniques with your birthing partner (e.g., massage therapy, reflexology, relaxation and breathing exercises and aromatherapy). By rehearsing the same techniques over and over, it becomes second nature when you need it most — plus it's a good way to see what has the best effect on you before the big day.

Tips for a natural birth

Once you do hit the delivery room, a few steps can help increase the odds that you make it all the way to the last push without medication or interventions:

• Take it one minute at a time. A wave of contractions lasts about one minute, and then you get relief. If you take things minute by minute — and try to keep your mind off of the journey ahead — you're more likely to make it through without pain medications.
• Visualize a successful birth. Many Olympic winners rehearse the race in their heads before they compete. Do the same: Picture your baby coming out of your body easily. Visualize a successful outcome, have faith in it, and keep going back to that picture during the labor process. Believe in the power of positive intention, and know that you are strong and your body will get you through.
• Limit the number of people in the delivery room. While it might seem encouraging to have all of your closest friends and family by your side, too many people can ultimately be more of a distraction than assistance. Research has shown that having more people in the birthing room actually slows down labor, which could make it harder to stay medication-free. There's a reason why dogs and cats instinctively hide somewhere to be alone when delivering their young — to focus on the task at hand.

Remember, if you want a “natural birth” you don’t have to go all natural to get the benefits. And know that there's nothing wrong with asking for pain relief if you need it — don't get down on yourself if you do.