Somewhere along the way, the conversation about pain relief in labor turned into something it was never meant to be: a competition. A test. A measure of how 'strong' you are.
It's none of those things.
If you're trying to decide between planning for an unmedicated birth or planning to use an epidural — or somewhere in between — you're in good company. This is one of the most common questions expecting parents ask, and it's also one of the most polarizing topics in birth spaces online.
Let's cut through the noise and look at what the evidence actually shows.
What the numbers say
About 73% of birthing people in the U.S. used an epidural, spinal, or combined spinal-epidural block during labor, according to research published in JAMA Network Open using 2015 national birth data. Rates vary widely by state — from roughly 37% in the lowest-use state to over 80% in the highest.
That means roughly one in four labors happens without an epidural. Both paths are common. Both are valid.
Why some families choose unmedicated birth
People choose unmedicated birth for a range of reasons, and they're personal — not political:
- They want to feel everything — Some people describe wanting to be fully present, to experience the sensations of labor without numbing or filtering
- They want to avoid potential epidural side effects — While epidurals are generally very safe, there are low-probability risks some families prefer to avoid
- They want more freedom to move — An epidural limits mobility, and some people want the ability to change positions, walk, or labor in water throughout
- They want to see what their bodies can do — For some, it's simply a personal goal, and that's enough
Why some families choose an epidural
Just as valid:
- Effective pain relief — Epidurals are the most effective form of pain relief available in labor, and for many people, that makes labor a more positive experience
- Rest during long labors — A 30-hour labor is grueling. An epidural can allow someone to rest, conserve energy, and be more present for pushing and meeting their baby
- Medical recommendation — In some situations — high C-section risk, certain heart conditions, preeclampsia, twins, or a breech baby — a care provider may recommend an epidural as the safer option
The research on satisfaction
Here's what's interesting: studies consistently show that the type of birth doesn't predict satisfaction nearly as much as whether the person felt informed, supported, and respected during the process.
A person who planned an unmedicated birth and got one can have a wonderful experience — or a traumatic one if they felt unsupported. The same is true for someone who planned an epidural.
The common thread is continuous support. Research shows that having a doula or dedicated support person reduces the likelihood of C-section by 25-39% and increases satisfaction with the birth experience — regardless of pain medication choices.
So how do you decide?
Some things worth thinking through:
- What matters most to you about your birth experience? Not what your sister, your friend, or an Instagram account thinks — what you want
- What does your body need? If you have medical factors that influence the decision, talk to your care provider
- What's available where you're giving birth? Some hospitals offer nitrous oxide (laughing gas) as an intermediate option that relieves anxiety without blocking sensation
- Can you stay flexible? It's worth preparing for an unmedicated birth even if you know you want an epidural, just as it's worth knowing your epidural options even if you're planning unmedicated. Labor doesn't always read the birth plan
The bottom line
There is no award for suffering, and there is no shame in pain relief. Every birth is a real birth. Every birth takes strength.
Your birth is yours. No one else's.
This post is for educational purposes only. Talk to your care provider about what's medically appropriate for your specific pregnancy and birth.