Thursday, April 1, 2010

Letter to a Friend: Avoiding Epidurals

I recently received this question from a high-school friend (who has probably noticed my birth-obsession on Facebook): "I am about to have my first baby; how do I avoid an epidural?"

This is what I wrote; if anyone would care to make additions, I'd love to hear them!


Dear ------,

My friend, that is a dangerous, dangerous question.... You may never get me to shut up. THEN where will you be? :)

Okay.... Well, I could write for hours on this topic. I'll try to condense, so feel free to ask me to clarify. Or to just be quiet.

I have had two drug-free, all-natural births. They were the hardest thing I've ever done, but also the most empowering, transformational, life-changing events of my life. I wouldn't change it for anything, and any more babies we have will (hopefully) enter the world the same way.

To be completely honest, the thing that helped me get through probably the most was simply not having pain meds available. I chose to birth at home with a midwife, where pain medication is not an option. That honestly helped a lot, because I didn't have to think "should I, shouldn't I, etc." - I could just focus on getting on with the job without that struggle. It's a bit trickier in-hospital.

In answer to the question "How can I have a natural birth?", I would honestly say that the most effective techniques have nothing to do with labor and everything to do with before-labor preparation. Here are some things that come to mind:

(1) Reading. SO important. That way you can be an informed consumer and really know what you want. Do you want to avoid an episiotomy? How about an induction? Do you want to remain mobile throughout labor? Use an upright birthing position? Do you want baby to have vitamin K shot or the Hep B vaccine? Do you want an IV? Do you want delayed cord clamping? It's so helpful to know the issues and know what you want. That will also help you in-hospital when various interventions are offered - you'll know pros and cons. In the middle of labor is not the best time to be asking questions and trying to learn about labor & delivery care, LOL!

Here are some of my favorites:

"The Thinking Woman's Guide to a Better Birth" (Henci Goer)
"Creating Your Birth Plan" (Marsden Wagner)
"Active Birth" (Janet Balaskas)
"Ina May's Guide to Childbirth" (Ina May Gaskin)
"Pushed: The Painful Truth About Childbirth and Modern Maternity Care" (Jennifer Block)
"Hey! Who’s Having This Baby, Anyway?" (Breck Hawk)
"Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First" (Marsden Wagner)
"Giving Birth"
"Gentle Birth Choices" (Barbara Harper, RN)
"Our Bodies, Ourselves: Pregnancy and Birth" (Boston Women's Health Book Collective) *
"The Natural Pregnancy Book" (Aviva Jill Romm) *

(2) Taking really good childbirth classes is SO helpful. And while hospital classes can occasionally be okay, usually they're not. They're generally not about "how to get a natural birth" - they're usually about "how to be a good patient and do what we tell you without asking questions." They vary. There are occasionally good ones out there. But out-of-hospital classes are usually very good. My favorite methods are Bradley and Hypnobabies (not Hypnobirthing). The longer the better.

(3) After one has figured out exactly what one wants, it's helpful to make sure that one's OB or midwife is on-board. Having a supportive care-provider can make or break a natural birth. If I say "I want delayed cord clamping, an upright birth position, water for pain relief, and no IV" and my careprovider says "no" or hems and haws, I know it's time to change careproviders.

(4) My number one help for a natural labor is hiring a doula. There is nothing like having a knowledgeable and helpful trained doula on your birth team to help have a natural birth. She would also be extremely helpful to your husband as well. I could go on and on about doulas, but I already wrote about that, so here's that piece:

Doulas can be anywhere from free to quite pricey. Having now had both, if I had to do it again, I would choose the pricey one (for experience). However, there's a doula to fit everyone's budget.

(5) As for actual things to use in labor:

If you use a doula, she will have a whole arsenal of pain-relief techniques to use, and she can discuss those with you before your birth. Things that worked for me: laboring in water, either the tub or the shower; vocalizing during contractions, being free to move around, being undisturbed in a room with low lights so that I could concentrate, not knowing my dilation (knowing one's dilation and being checked a ton can be extremely discouraging - at least it was to me!), having my doula touch and talk me through contractions (that was super helpful), being surrounded by a supportive birth team (SO helpful - they would say things like "You are doing great! You can do this!" instead of "Are you sure you can do this? Do you want something for the pain?")

Anyhow, does that help any? Birth lore is my hobby, so I spent a lot of time immersed in the subject. Feel free to email me any other questions.

Regardless of how baby comes (natural, non-natural, cesarean, etc.) - it will be the most precious day of your life!!! :)


P.S. Oh, oh, oh! Forgot one really cool thing - "The Business of Being Born" movie is informative and also entertaining (also a great way to show your husband things without bogging him down with books).

P.P.S. I finally found the link I was looking for on comfort measures! Here it is:


Thoughts, anyone?


  1. yes, yes, yes! great list. i would say the biggest thing for me was mental preparation. i had read so much about it, that when it came time, i had all the confidence i needed to get me through it. if you are in a hospital, most definitely - a doula. i didn't have a doula with my first (a hospital birth) and i had an epidural, even though i wanted to go naturally. you need that support!

  2. Hi Diana I'm contacting you as I loved your post as a mother and a midwife! I'm working in New Zealand and we are contemplating a move to Arizona. I would love it if you would contact me as I have a lot of questions to get answered first. My address is (not the google one that comes up here- long story, but can't figure out how to change it right now!)

  3. I did all the things you recommended except taking classes (though my doula actually TEACHES classes at the hospital) - love the list.

    I would add: surround yourself with positive birth stories. If you can't find them in real life, Google them.
    Pay no attention to passive-aggressive women who aim to scare/shock you.
    I am 37.2 weeks and dealing with this much more frequently nowadays.
    Stay away from anything that fails to "normalize" birth - "Baby Story" type crap where everything is an emergency, etc.

    YouTube is full of beautiful natural birth videos.



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