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Women have been giving birth naturally throughout history, but what are the risks and benefits to natural birth, i.e. avoiding epidurals and analgesics? Is having a natural birth statistically more or less risky than getting an epidural?

  • This depends entirely on the individual. Some find it very painful, some find it very easy to cope with. There are actually more risks with things like epidurals (as they can make it harder for the mother's body to react correctly) – Rory Alsop Jan 21 '15 at 8:34
  • When are you due? Reading this and your other question, you seem to be a quite nervous expectant mother? Perhaps we could allay your fears otherwise? – Stephie Jan 21 '15 at 8:52
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    I had my first with no epidural. Was it hard and painful? Yeah. Worst pain I'd ever experienced? Yeah. Doable? Also, yeah. – Acire Jan 21 '15 at 12:43
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    If you're looking for facts and not opinions, you might want to rephrase your question somewhat; ask for studies or statistics if you're looking for something like that. – Joe Jan 21 '15 at 15:48
  • Don't forget to check with your insurance company. Going natural in a birthing house can cost you tens of thousands because for some reason insurance companies like to not support this. Why? I don't know. Just happened to someone we know. – Kai Qing Jan 23 '15 at 0:28
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Of course it can be done and it happens thousands of times every day.

The key questions for you is probably "Is the the right choice for me and our baby?".

This depends on a variety of factors, a lot of which are very personal, so only you can decide. A few points

  1. There is a fair amount if research out there on which one is "better". Unfortunately a lot of it is very biased so it's difficult to get an objective view. The World Health Orginazation has published http://www.who.int/maternal_child_adolescent/documents/who_frh_msm_9624/en/ .
  2. There are risk factors associated with home births and there are risk factors associated with clinical birth
  3. Requirement for a home birth is that everything is "normal" and that there are no specific pre-identified risks.
  4. A well trained birth attendant (mid wife) is vitally important. It's great if you can establish a good relationship with the mid wife during the preganancy.
  5. There ought to be an emergency plan so if things go wrong, you can react quickly.
  6. There is enormous cultural bias. While a doctor in Germany yelled at us "do you want to kill your child", 100 miles across the border in the Netherlands it's a complete non-issue and home birth is very frequent.

This being said, we had all three kids at home without pain treatment and it was a wonderful experience. You are in control of most of the process and you are in a comfortable environment with people that you know and trust. That's the right thing for some people, but not for others, so it's a very personal choice.

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    +1 - this is an excellent answer; I can think of none better, and I have delivered a great many babies. – anongoodnurse Jan 21 '15 at 14:37
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    This answer seems to be about home birth vs clinical birth, rather than about the use of pain relief. – Remco Jan 21 '15 at 15:39
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    @DavidMulder No, actually not. Home birth is as popular (and encouraged) as ever. A study published in 2009 wasn't able to find any difference in mortality rate for home births vs. low risk elective clinical births. My personal suspicion is that the Dutch laid back attitude to medical procedures in general might play a role (I'd say that countries like Germany and the US are definitely overmedicalised, but the NL in comparison is definitely undermedicalised). – Little Ms Whoops Jan 21 '15 at 17:05
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    I'd have to say, without wanting to join a "discussion" about home vs clinical popularity in the Netherlands [Citation needed]... "A study presented...", "I have lectures..." aren't relevant without links to back up said claims. After all, 93% of statistics are made up on the spot... – WernerCD Jan 21 '15 at 18:20
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    The one I heard was 'never trust a statistic you haven't faked yourself' :) @DavidMulder, I'm critical of the Dutch system myself (heck, I'm definitely going to hospital! But I'm hoping that pain relief won't be necessary), but I don't think it's that easy to point towards home births as the culprit. I did a quick google search and came up with very recent articles (2013/2014) going both ways, authored by VUMC researchers - I guess there just aren't any definitive conclusions yet. – Little Ms Whoops Jan 21 '15 at 21:00
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Childbirth hurts. It always has. But the amount of pain you experience depends on many factors, such as the position of the baby, whether you have or haven't ruptured the amniotic membrane, your pain threshold, your anxiety level, your position in labor, and a host of other factors, many of which you have no control over. Can a first time mother do it without pain meds? Absolutely.

Most physicians (and here I can only speak to the US) don't have enough training in natural deliveries to really help the mother that way (there is a reliance on drugs for pain relief), so I agree wholeheartedly with @HelenM and @Hilmar (That answer was not posted when I started to answer this, or I would simply have commented on my complete agreement with @Hilmar) to get yourself a good, experienced midwife or birth coach who could help you through it and find a breathing and relaxation method you and your partner agree on and practice ahead of time, if you have decided on that route. Even if you have not, I would still recommend you look into it.

This topic draws strong opinions not necessarily based in fact. There are a great many people who are absolutely convinced that you should do it without pain medications, just because they have, or their bias towards all things natural.

The best advice I can give you is to plan for the best and prepare for the worst. Definitely practice breathing and relaxation, because it will help you regardless of whether you choose pain meds or not. Have a back-up plan in case things aren't progressing the way you and your midwife would like. The baby has to come out, and it is very highly likely that you will not be scarred for life by the experience. If it wasn't worth the final result, people in a position to choose would only have one child.

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    +1 For the last two paragraphs. We tried to go the natural route and my wife couldn't bear it.Good stuff from you as always @anongoodnurse. – Brian Robbins Jan 21 '15 at 14:48
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    +1 for noting that the choice of health care provider (e.g. physician vs. midwife) can push you towards either more or less "natural" childbirth. Choose a practitioner that supports your personal preferences (while still knowing if/when to intervene, e.g. if a C-section is necessary, of course). – Acire Jan 21 '15 at 14:52
  • @anongoodnurse, what do you know about birth preparation courses? I'm just attending one given by a women heralded as 'the guru of birth preparation courses in the Netherlands', and what she says is that even more than relaxation and breating, it helps knowing how to push and which muscles to use - first backwards to help the baby through the pelvis, then downwards/outwards. However, I don't know how much of that is common knowledge elsewhere. – Little Ms Whoops Jan 21 '15 at 17:05
  • @LittleMsWhoops - I'm only trained in Western Medicine. :( I never heard of using different muscles to push (honestly, I think the uterus does all the pushing until close to the end, and you do need to control how you push towards the very end) But if your teacher knows more than I do, I would believe her over me. :-) Sounds like you have a good teacher, which is so important. About breathing, I did encourage all my patients to take Lamaze, but until I had my first, I didn't really appreciate how helpful it truly was. – anongoodnurse Jan 21 '15 at 18:57
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I did it and would do it again! I felt there were more risks with epidural and other pain relief methods than doing it the old-fashioned way. That said, I would recommend to anyone doing it naturally to have a midwife, a doula, or a birth coach who has assisted a birth before (not your partner!), who can advise the best positions for pain relief and know how to aid and speed labour naturally. I also read up on relaxation exercises during labour (Bradley method, but there are others) ahead of time with my partner.

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Women have been giving birth for millenia, mamals have been giving birth for millions of years. It is possible and it actually happens a lot.

In my country most women do not choose pain relief. There are some complications possible, which is an additional risk.

During the few days I spent around the delivery ward I've seen women who gave birth a few hours ago already happily walking around with their babies. There's no rule on how much will the childbirth hurt or how long will it last.

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This question is asking about giving birth without pain relieve, but all answers are addressing the idea of natural birth/without hospitalized care.

Home birth

Let me first address home birth as that's likely what you're thinking of. I dare say that home birth without a doubt in my mind is more dangerous for both the mother and the child. Now, I can back this up scientifically and I will in a second, but think about it like this: if something goes wrong getting to the hospital is going to take time. During that time a lot can (and does) happen. And there is nothing that makes home birth safer for the child or the mother to make up for this.

Now, just to back this up with some facts. A lot of Dutch people have weighted in on this topic, but they fail to note that the Netherlands have one of the highest child mortality rates of Europe (and the western world in general) and maternal mortality has even risen in the Netherlands since the 80-90. Now, this can be attributed to a great deal due to the tendency of giving birth at far later ages when it's far more dangerous (and worse for the child long term), but that same is true for more countries in the western world and the Netherlands are still doing worse then them. Either way, there are a lot of articles on this topic and here is one I found that looks quite good.

Pain relieve

Now, first of all there are two types of pain relieves of course pharmaceutical and non-pharmaceutical. Assuming we're talking about pharmaceutical there are various drugs that are used and a relatively more relaxed mother will increase the chances of a safe child birth. Now, I am not going to discuss the side effects of some of these drugs (some are potentially pretty dangerous), but let me just say that as far as I know something like the typical mixture of nitrous oxide and oxygen has no relevant negative side effects and does help the mother relax. Now, the effect isn't huge in both directions, so making a choice in this regard is something you can safely do without worrying (too much) about the child.

Concluding

All in all home birth is an extremely bad idea (sorry for putting it this harshly, but take a look at the statistics), choosing not to opt for pain relieve however is a perfectly fine idea. Especially some of the more effective pain relieve drugs can even be dangerous and avoiding those might not be a bad idea. The lighter ones such as the gas mix I wouldn't worry that much about and are likely even slightly beneficial, but not using it on grounds of wishing to fully experience the birth as I have heard some people wish is just as fine.

  • Only one of the other answers (so far) addresses home birth, and the question does not mention it at all. – Acire Jan 21 '15 at 17:48
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    @Erica You seem to have glanced over this, but a lot answers are assuming it to be the same thing which becomes clear by the advice that is being given even if they don't spell it out (preparing for emergencies, presence of a midwife, etc.). – David Mulder Jan 21 '15 at 17:52
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    @Erica Well, all I can tell you for sure is that every Dutch person who weighted in on this topic meant that with those comments. To take a random answer, if somebody says "In my country most women do not choose pain relief. There are some complications possible, which is an additional risk." you are proposing that he or she meant that pain relief causes complications? – David Mulder Jan 21 '15 at 18:13
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    The OP's Question is not about home birth, nor about prevailing attitudes towards pain medication in the Netherlands. Rebutting answers should be done with comments and rarely forms the foundation of a good Answer; you've instead responded to a different (inferred) question about whether home birth is a good idea or not. Also, the eventual answer to the second half of the OP's question (are there risks to avoiding epidurals, anesthetics, and medication?) is rather vague and uninformative -- "slightly beneficial"? -- and feels like an afterthought. – Acire Jan 21 '15 at 18:29
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    For what it's worth I do agree that home birth is a less safe choice. I only argue that this isn't necessarily the appropriate Question to present that point :) – Acire Jan 21 '15 at 20:03
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Bear in mind that pain relief can take many forms, from a "whiff of gas", as the nurses put it, to an epidural, with various oral medications in between. I had a small amount of gas with my first child. It helped me relax and speeded up the delivery. The effects of the gas do not last long, so basically, it's a full monty. The gas just takes the edge off briefly, and that can help you through a rough spot. An epidural can (if it works properly), basically remove all sensation.

I'm not sure that being a first timer is relevant here. It's more a question of how rapidly the labour progresses, when the water breaks, whether other interventions are necessary (like oxytocin to induce).

My advice, for what it's worth, is to take the advice of the L&D nurses. They know all the tricks, and they often know what sort of intervention (pain relief, changing position, going for a walk), will get you through it and speed things up. I have 4 children with 4 different birth experiences. In every case, the nurses were a big help.

The danger of not taking pain relief is that you can tense up under the pain, which then slows down the delivery, which leads to more pain. Natural childbirth methods of relaxation are aimed to break the tension-pain-tension syndrome. You definitely want to have them in your arsenal ... but what if the tension and pain get ahead of you? Do you want to add hours to your delivery when a spot of pain relief might get you over the hump? I mean, that's what happened, back in the day. Remember, too, that the moment that baby is born, you get launched on a 24-7 motherhood project that only ends when they go to college. You don't want to be so exhausted that you can't enjoy the baby.

  • I have a deep respect for nurses (my son is a nurse, and I've worked with many incredible nurses), but I disagree with you about L&D nurses, as both a doctor & patient; they are trained in traditional western medicine, and if anything (again, my experience) they tend to protect the doctors at the expense of the patients (after all, they have to keep working with the doctors, who can make their lives miserable; the patients come and go.) I would definitely recommend an experienced midwife. Also, mothers are more anxious the first time, which can add to the level of discomfort. – anongoodnurse Jan 21 '15 at 16:22
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My wife gave birth to our 2 boys at home with no medication. We went to 'hypnobirthing' class (5 times I think) and practiced at home a few months before delivery.

Obviously I can't express how my wife felt exactly, but it seemed to be the length of labor that was hardest (physically tiring) rather than 'pain' (which came at the end).

Hypnobirthing is definitely worth looking at, you are not really 'hypnotized', it's probably a poor name. Instead you are in a state of relaxation and able to ride through the contractions better.

As a man, I imagine a contraction to be something like a stomach cramp, a cramp makes you want to grimace and curl up, but if you can relax then the discomfort eases.

Child birth is not easy, and it's slower the first time, but afterwards my wife wanted to do it again - it was a powerful and emotional experience obviously. The hypnobirthing approach tries to 'unfear' you from it, which I think is important. In our culture everything about child birth implies screaming and pain, but it doesn't have to be that way, my wife never screamed. Being afraid and tense is your only enemy.

From my perspective one thing I would say is having a midwife you are comfortable with, and who gets what you want, is important. You need to be relaxed and on the same page.

Talking of midwives, and I say this as credit to hypnobirthing, our wonderful midwife was so impressed with the first delivery that she came on her night off for the second delivery because she wanted to be there.

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