Labor Pain Management: All Your Options, Honestly
You are not stuck choosing between "natural" and "get me an epidural." There is a whole spectrum in between, each with genuine benefits and real trade-offs. There is no right answer here, only the one that fits your values and your situation.
Pain medication exists for a reason, and using it is not failure. Neither is skipping it. A reader should be able to walk away feeling equally good about an epidural or an unmedicated birth. Here is the full menu, with both sides of each choice laid out plainly.
Why Informed Parents Decide Differently
Before the details, here is the heart of this decision and the honest case for each path. There is no right answer to pain management, so the useful question is not which path is best but why thoughtful, well-prepared parents land in different places.
Why an informed parent might plan an unmedicated birth
Your body does not just create labor pain, it creates the tools to manage it. As unmedicated labor builds, your own oxytocin brings calm and pain relief and your endorphins, your body’s natural opioids, rise until by transition they can reach roughly ten times or more your normal levels. That system works best undisturbed, so a parent on this path is choosing full mobility to move and change positions, an alert baby and faster recovery, and the chance to avoid the intervention cascade that a Pitocin-and-epidural sequence can set off. It leans on an active toolkit, movement, breathing, water, and continuous support, rather than on a single medication. This is a valid choice based on real benefits, not a badge of honor, and it asks for real preparation and a supportive provider.
Why an informed parent might plan for an epidural
For pain relief alone, the epidural is the gold standard: most women move from severe pain to mild discomfort or pressure, and in a long labor it can let an exhausted mother finally rest, conserve energy for pushing, and sometimes help a stuck labor progress. A parent choosing it is accepting the real trade-offs with eyes open, restricted movement, continuous monitoring and an IV, a longer pushing stage, and a genuinely higher risk of fever and its follow-on effects on the baby. Weighing effective, reliable relief and rest as the priority, and accepting those costs, is an informed and responsible call. An epidural is not a failure.
Why an informed parent might stay flexible
Many parents do not decide the whole thing in advance, and that is its own considered choice. You might plan to labor with movement and breathing first, keep nitrous oxide available, and hold an epidural as backup, reassessing in active labor rather than under duress. This path treats the spectrum as something you can move along as your labor actually unfolds, with no hierarchy where one option outranks another. Changing your plan during labor is not giving up, it is responsive care, and using pain medication when it becomes what you need is adapting, not failing. The goal is a healthy mother and baby and a birth where you felt supported, not any single approach at any cost.
These are not the choices of parents who did not do their homework. Equally informed parents, looking at the exact same evidence, reasonably arrive at different conclusions, because they are weighing different priorities. That is the whole point: there is a version of this decision that is right for your family.
Think of It as a Spectrum, Not a Switch
Labor pain is real. It is also temporary, purposeful, and something your body is designed to handle. On one end sits fully unmedicated birth: complete mobility, full sensation, and typically the fastest recovery, but the most preparation. In the middle are options that take the edge off, like nitrous oxide and IV medications. On the other end is the epidural: highly effective pain relief that also restricts movement and triggers additional interventions.
Most women can move along this spectrum as labor unfolds. You might start with movement and breathing, try nitrous oxide as things intensify, and choose an epidural if labor becomes prolonged. Having a plan does not lock you in. What matters is deciding before labor begins, while you can still think clearly, and staying flexible enough to adapt.
What Often Goes Unsaid
About 70 to 75% of births in the US use an epidural, and in some hospitals the rate is over 90%. It is genuinely excellent at pain relief. What women are less often told is the rest of the picture: epidurals dramatically raise the risk of fever (in one study, 14.5% with an epidural versus 1% without), can slow labor, and start a cascade of additional interventions like continuous monitoring, IV fluids, and bladder catheterization.
The flip side is just as under-told. Many women hoping for an unmedicated birth have not done the preparation that makes it more likely to succeed. Neither gap is the woman's fault. It is a system that rarely walks you through the full trade-offs before you are in the middle of labor. That is what this page is for. There is no hierarchy here and no medal for going without.
Your Four Main Options
Unmedicated Birth
Complete mobility, full alertness, typically faster recovery, and no medication effects on your baby. Among nearly 56,000 women surveyed, 72% wanted to give birth this way, so it is far from a fringe choice. Your body produces its own pain management: oxytocin, which has direct pain-relieving properties, and endorphins that can rise to roughly 10 times or more normal levels by transition, the most intense phase of labor. Success comes from real preparation: a comprehensive childbirth class (like Bradley or HypnoBirthing), continuous support, freedom to move, access to water, and a provider who genuinely backs your choice. Movement and upright positioning are among the most evidence-supported tools, and one study found upright positions shortened the pushing stage by about 6 minutes on average.
Nitrous Oxide (Laughing Gas)
A middle ground you self-administer through a mask during contractions. It does not eliminate pain; it relieves anxiety and helps you cope, and it wears off within seconds when you stop. It keeps you mobile, does not slow labor, and has no adverse effects on baby, so you can breastfeed right after birth. The honest caveats: it may cause nausea (up to 46%) or dizziness (up to 23%), availability is still limited in US hospitals, and many women who use it (about 69% in one study) later switch to another method, most often an epidural. Think of it as one tool, not a complete solution.
IV Pain Medications
Opioids like fentanyl given through your IV. The honest truth from research: they provide minimal and unreliable pain relief, with little effect on pain scores compared to placebo, yet they carry side effects for you (nausea, drowsiness) and baby (possible respiratory depression, decreased alertness in the early hours). Timing matters a lot: given too early they can slow labor, and given too close to delivery they raise the risk of respiratory depression in the baby, which can be reversed with a medication hospitals keep on hand. They are more of a "take the edge off" option than a strong pain management tool, and can fill a niche in early labor or when an epidural is not available.
Epidural
The most effective pharmacologic pain relief available, and the gold standard for pain relief alone. Most women move from severe pain to mild discomfort or pressure, and it lets you rest and conserve energy in a long labor. The trade-offs are real: restricted movement, longer labor (roughly 30 minutes in the first stage and 15 minutes in the second compared to other pain relief), a much higher fever risk, and a cascade of additional interventions like IV fluids, continuous monitoring, and often a bladder catheter. Fever matters because it can trigger sepsis evaluations and antibiotics for your newborn. Asking about a low-dose or "walking" epidural, and waiting until active labor, can reduce some of these effects.
Pain With a Purpose: Movement and Positions
Here is something that gets lost in the "how do I make it stop" framing: labor pain carries information. It is often a cue. A sharp change in sensation, or pain that concentrates in one spot, can be your body signaling that a position change would help your baby move down and your labor progress. There is a feedback loop between you and your baby, where your baby's positioning prompts your body to adjust. Instead of only trying to escape the pain, you can respond to it.
Why staying mobile helps
Movement and positioning may be the most evidence-supported coping strategy there is. Standing, walking, swaying, hands-and-knees, squatting, and side-lying all help shorten labor and give you something active to do. In one study, women who used upright positions had a shorter pushing stage by about 6 minutes on average, reported less pain, and expressed greater satisfaction. Changing positions every 20 to 30 minutes promotes labor progress, decreases pain, and improves the overall experience.
There is a mechanical reason this works. MRI evidence shows your pelvic outlet actually becomes wider when you squat, kneel, or get on hands and knees compared to lying on your back, and squatting can open the pelvic outlet by roughly 28 to 30 percent. That is real extra room for your baby to descend and rotate, plus the help of gravity.
A few positions and tools to try
- Walking, especially early in labor, keeps your pelvis moving and helps your baby descend.
- Hands and knees significantly decreases back pain and can encourage a baby who is facing the wrong way to rotate into a better position.
- Squatting opens the pelvis and relaxes the perineal muscles, and uses gravity to assist your baby's descent.
- A birthing ball lets you keep moving while providing support, and a peanut ball can open the pelvis even if you are lying down with an epidural.
- Counter-pressure and hip squeezes from your partner, firm pressure on the sacrum or squeezing both hips inward during contractions, can bring immediate relief.
This is one reason an epidural involves a trade-off: once your movement is limited, you lose easy access to these position changes. A low-dose or "walking" epidural, and tools like a peanut ball, can preserve some of this benefit.
Prepare Before Labor: Your Coping Toolkit
The single most under-used pain tool is preparation. Fear increases pain. The fear-tension-pain cycle is well documented: fear triggers stress hormones that tighten your muscles, which makes contractions more painful, which feeds more fear. Education breaks that cycle by replacing the unknown with understanding, and relaxation training breaks the tension part of it. Women who complete comprehensive childbirth education tend to have lower cesarean rates, fewer interventions, and higher satisfaction, regardless of which method they choose. Any comprehensive class beats none, even if you are planning an epidural.
The Bradley Method (partner-coached natural birth)
Developed in 1947, the Bradley Method is a complete approach to natural birth built on partnership between you and your birth companion, not just breathing techniques. Couples attend about 12 weeks of classes and practice daily, so that when labor begins your brain is already trained to relax when it hears your partner's voice using familiar techniques. Your partner is not a bystander offering encouragement; they are trained to recognize when you need more support, help maintain relaxation, and be your anchor through each contraction. It also emphasizes nutrition and a daily exercise routine (tailor sitting, pelvic rocking, squatting, and Kegels).
Proponents report that about 86% of women who complete the method achieve unmedicated vaginal birth. That figure comes from method advocates rather than independent research, and for context, only about 17% of women in the general US population have an unmedicated birth. Still, studies do confirm that relaxation and deep breathing can be effective pain management when properly trained.
HypnoBirthing and Hypnobabies (self-hypnosis)
These methods are built on a simple idea: fear and tension increase pain, while relaxation and positive suggestion reduce it. You learn self-hypnosis to stay calm, visualize positive birth scenarios, and reframe pain as pressure or waves. A Cochrane review of nine trials found that women in hypnosis groups were less likely to need other pain medication. The evidence base is still limited, but the mechanism makes sense, the approach is safe, and many women report genuine benefit.
Lamaze (informed decision-making)
Modern Lamaze is very different from the "hee-hee-hoo" panting parodied in movies. Today it centers on evidence-based maternity care and informed decision-making, organized around six healthy birth practices, including letting labor begin on its own, moving and changing positions throughout labor, continuous support, and following your body's urge to push. It does not tell you whether to get an epidural; it teaches you how to make that decision for your circumstances. It is a strong fit if you are planning a hospital birth and want to stay informed and empowered without committing to unmedicated birth.
The rest of the toolkit
Alongside a class, most unmedicated coping comes down to a handful of tools you can practice ahead of time: continuous support from a partner or doula, freedom to move and change positions, water immersion in a warm tub (which many women describe as "nature's epidural" and which lowers epidural requests), slow deep breathing with a longer exhale than inhale, low vocalization (deep moans rather than high-pitched sounds, which open the throat and relax the pelvic floor), touch and massage, and hot or cold therapy.
One caution on breathing: forget the rapid, shallow Hollywood panting. Hyperventilation increases pain and anxiety and can cause dizziness and tingling. Real labor breathing is slow and deep, because it reduces tension and calms your nervous system.
The Epidural: Benefits & Trade-Offs
Benefits
- Excellent, reliable pain relief, often turning severe pain into mild pressure
- Lets you rest and conserve energy during long labors
- Keeps you alert and present, unlike sedating IV opioids
- Can be a genuine relief if labor becomes prolonged or exhausting
Trade-Offs
- Dramatically higher fever risk (about 14 times higher in one study), which can trigger sepsis workups for your baby
- Restricts movement and often requires a bladder catheter and continuous monitoring
- Lengthens labor and can make pushing less effective
- May increase the need for vacuum or forceps, raising the risk of severe tearing
- Linked to lower early breastfeeding rates and reduced newborn alertness
None of these trade-offs makes an epidural the wrong choice. They make it a choice worth understanding in advance. If your priority is pain relief and conserving energy for pushing, an epidural does that better than anything else available.
Questions to Ask Your Provider
- Does your hospital offer nitrous oxide, and how do I request it?
- Do you offer a low-dose or "walking" epidural that preserves some movement?
- What is your fever protocol with an epidural, and how would it affect my baby?
- Can I labor in upright positions and change positions during labor?
- How do you support women who want an unmedicated birth?
- Can I wait until active labor to decide on an epidural?
Our Take
There is no "right" answer to pain management. The best choice is the one that matches your values, your situation, and your support system. What concerns us is not which option women pick, but how often they pick it without full information: many choosing an epidural do not know about the fever risk or the intervention cascade, and many hoping for an unmedicated birth have not done the preparation that makes it more likely to succeed.
If you want an unmedicated birth, commit to real preparation and a provider who genuinely supports it. If you want an epidural, understand the trade-offs and ask about timing and low-dose options. If you are flexible, build options into your plan, like laboring without medication first and reassessing in active labor. Changing your mind during labor is not failure. It is responsive care. "I did it without drugs" is not a badge that makes one birth better than another, and no one owes anyone an explanation for the path they choose.
A healthy baby and a mother who feels supported: that is the goal, not any one method at any cost. Your birth. Your body. Your baby. Your choice.
Sources
This article is drawn from our research guide. The sources below are the peer-reviewed studies and clinical guidance behind the key facts on this page.
- Haines, H. M., et al. (2012). What characterizes women who want to give birth as naturally as possible without painkillers or intervention? Midwifery, 28(4), 458-464. doi.org/10.1016/j.midw.2011.07.011
- CDC National Center for Health Statistics (2008). Epidural and spinal anesthesia use during labor. National Vital Statistics Reports. Note: Latest official CDC data shows 61%; current estimates of 70-75% reflect more recent state-level data and industry consensus.
- Browning, C. A., Trudinger, B. J., & Martin, T. (1983). Maternal and fetal beta-endorphin release in response to the stress of labor and delivery. American Journal of Obstetrics & Gynecology, 148(4), 440-445. PubMed: 3158206.
- Lothian, J. A., et al. (2016). Comparison of the Bradley Method and HypnoBirthing childbirth education classes. Journal of Perinatal Education. PMC4744344. Note: The 86% statistic is self-reported by method advocates.
- Madden, K., Middleton, P., Cyna, A. M., et al. (2016). Hypnosis for pain management during labour and childbirth. Cochrane Database of Systematic Reviews. doi.org/10.1002/14651858.CD009356.pub3
- Cluett, E. R., Burns, E., & Cuthbert, A. (2018). Immersion in water during labour and birth. Cochrane Database of Systematic Reviews. doi.org/10.1002/14651858.CD000111.pub4
- Gupta, J. K., Sood, A., Hofmeyr, G. J., & Vogel, J. P. (2017). Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews, 5, CD002006. doi.org/10.1002/14651858.CD002006.pub4
- Russell, J. G. (2002). MR obstetric pelvimetry: Effect of birthing position on pelvic bony dimensions. AJR American Journal of Roentgenology, 179(4), 1063-1067. PubMed: 12239066.
- Buhre, W., et al. (2020). Nitrous Oxide for Labor Analgesia: What We Know to Date. PMC7755562.
- American Society of Anesthesiologists. (2019). Laughing gas helpful for labor pain, safe for baby, but ultimately most women switched to an epidural. ASA News Release. www.asahq.org/about-asa/newsroom/news-releases/2019/10/2-nitrous-oxide-during-labor
- Smith, L. A., Burns, E., & Cuthbert, A. (2018). Parenteral opioids for maternal pain management in labour. Cochrane Database of Systematic Reviews. doi.org/10.1002/14651858.CD007396.pub3
- Anim-Somuah, M., Smyth, R. M. D., Cyna, A. M., & Cuthbert, A. (2018). Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews, 5, CD000331. doi.org/10.1002/14651858.CD000331.pub4
- Lieberman, E., Lang, J. M., Frigoletto, F., et al. (1997). Epidural Analgesia, Intrapartum Fever, and Neonatal Sepsis Evaluation. Pediatrics, 99(3), 415-419. doi.org/10.1542/peds.99.3.415
- Dozier, A. M., Howard, C. R., Brownell, E. A., et al. (2013). Labor Epidural Anesthesia, Obstetric Factors and Breastfeeding Cessation. Maternal and Child Health Journal, 17(4), 689-698. doi.org/10.1007/s10995-012-1045-4
- Dahan, O. (2020). Birthing Consciousness as a Case of Adaptive Altered State of Consciousness Associated With Transient Hypofrontality. Perspectives on Psychological Science, 15(3), 794-808. doi.org/10.1177/1745691620901546
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Medical Disclaimer: This information is for educational purposes only and does not constitute medical advice. We are not doctors. Every labor is different. Always discuss your specific situation with your healthcare provider to determine the best pain management plan for you.
Last reviewed July 21, 2026.