“Epidural-Free Birth”
“An Epidural-Free Birth” (Part 1)
2025 has started out busy and productive. We are quieting down now, so it seems fitting to write about a topic that's been on my mind for a while.
An interesting MBS stat for 2025: 5 out of 7 births I supported as a doula this year so far were unmedicated/without an epidural for pain relief. I’m often asked to discuss this topic, so here we go:
**I’ll first start out with a disclaimer: Not everyone’s birth plan will or should contain pain-med/epidural free goals. This blog series is not to talk someone into a pain med-free birth. It’s NOT to shame anyone for using an epidural or needing to change their course about their labor. This is information to share for those who it does apply to. Epidurals are tools. Good tools and can make for good outcomes for many. This blog is NOT about that. You’ll find information here—and it may or may not be useful for you. Thanks for reading!**
One of the first conversations that I have with a client is their goal for pain management. It’s important to me that my clients know what an epidural actually is and entails. According to AmericanPregnancy.org: “Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than anesthesia, which leads to a total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.” A needle is used to open the epidural space, but then a small catheter is inserted in the epidural space and left there to deliver the medicine. These are important facts in understanding the epidural process and allow you to make a true, informed decision about your care.
Why does someone have a goal of not using an epidural for birth? Here are a few reasons my clients have given to me, their doula, over the years:
- They do not want to lose feeling or be numb.
- They want to be out of bed to walk around, use the toilet, etc.
- They don’t want additional interventions that come with the epidural, such as an active IV, a urinary catheter, constant monitoring, and others.
- They are scared of the unknown.
- They have a medical contraindication preventing them from receiving an epidural.
In birth, how does someone go about NOT needing or using an epidural? It’s one of my favorite questions to answer. This takes a lot of preparation and planning. It starts early with your doula, knowing your choices and options at your place of birth. (Side note: this is one of the reasons my schedule fills early for clients. Our conversations can begin even in the first trimester!) We talk about how your body perceives and copes with physical pain. We talk about emotional pain and discomfort. We discuss strategies for the phases and stages of labor and what “pain vs. suffering” means in the labor setting.
The biggest help to avoid an epidural: STAY HOME AND LABOR AS LONG AS POSSIBLE! The number one reason people change their pain-management strategy is being at the hospital too early. If home is a safe place for you, stay there until you shift into an active/transitional labor pattern. Talk with your doula about what that looks like in terms of symptoms; what are active strategies and what are rest strategies. Figure out what your “toolbox” has in it. Can your doula come visit you at the house if needed? How far away are you from your birthplace? These are all important points in making your pain-management goals.
Are there alternatives for non-medicinal pain support? YES. Some of my favorite alternatives for pain management are distraction, movement and position changes, hypnotherapies, hydrotherapy, a TENS unit, “good ol’ counter pressure and hip squeezing,” and Nitrous Oxide therapy.
Are there courses, classes, or teaching that can help avoid an epidural? Yes. There are many supports, and I suggest starting first with a class on physiological labor and labor expectations. This provides a needed foundation in understanding all the labor details. Maryland Birth Services offers this, and the course I teach is called Your Birth Essentials Class. I also suggest taking a Comfort Measures class with your partner and/or birth support. Other great options are the Bradley Method and Hypno-Babies or Hypno-Birthing. Taking some mindfulness classes or using calming apps can also be beneficial. There are studios that offer prenatal yoga with options for preparing for birth that are quite helpful for many. The main idea here is that preparation is often needed to go unmedicated in your birth experience.
What are some ways to engage this topic with birth providers? I suggest starting the communication early with your OB/midwives. Some questions to ask:
- What does an unmedicated birth often look like for a patient in your care?
- What options does my hospital provide for unmedicated labor? Does my hospital have labor tubs for birth?
- Is there a protocol for scheduled inductions that I should be aware of in this practice? (Check back for part 2 of our Epidural series for what this means and why it is important in avoiding an epidural.)
What are some tips to add to a birth plan for sharing my pain-management goals? Laboring at home, asking for intermittent monitoring to maximize movement, no restrictions on eating and drinking during labor, use of the shower and bathtub, access to birth and peanut balls, and use of nitrous oxide. Another great tip to consider—if you arrive at the hospital and are less than 5/6 cm and are comfortable going back home to continue laboring, do so. Again, if home is a safe space for you, completing a large part of your labor there will prove to have excellent benefits.
Check back later for Part 2 of “An Epidural-Free Birth.” We will discuss a very big point in labor that can often make a client change their needs for pain meds: inductions.
Be well!
