Epidural vs. Natural Birth: Risks & Benefits

Few birth decisions stir up as much debate as pain relief. Do you plan for an epidural, or aim for an unmedicated “natural” birth and ride out the contractions?

There is no single right answer, and today about three in four moms choose an epidural. This guide covers how an epidural actually works, why some moms skip it, and the honest risks and payoffs on both sides.

Use it to weigh epidural vs natural birth against your own pain tolerance, health history, and how you want your delivery to go.

Key Takeaways

Epidural: Regional anesthesia injected near the spine that blocks pain signals and numbs the lower body; about 75 percent of US vaginal births now use one.
Natural birth: An unmedicated vaginal delivery where the mother manages pain with breathing, movement, water, and support instead of drugs.
The trade-off: An epidural gives strong relief and rest but limits movement; an unmedicated birth keeps you mobile and alert but means feeling every contraction.
Your choice: The right call depends on your pain tolerance, health history, hospital setup, and how you want to experience labor.

In This Article

What's an Epidural?
What's a Natural Birth?
Epidural vs. Natural: How to Choose
Other Birth Options
Epidural vs. Natural Birth FAQs

Let’s start with the most popular form of pain control in delivery rooms: the epidural. Epidural or spinal anesthesia now covers about 75 percent of singleton vaginal births in the US, up from roughly 70 percent in 2016, and use has climbed across every age group and racial group ⁽¹⁾.

So why is it the go-to choice for so many moms, and is it right for you?

What Is an Epidural?

An epidural is a medical procedure where an anesthetic is injected into the epidural space of the spine. This blocks pain signals from traveling from your lower body to your brain. The epidural space sits between the dura mater (the protective covering of the spinal cord) and the bony spinal column itself.

Once the medication kicks in, it numbs the nerves. You might still feel pressure, but the sharp pain of contractions fades away. Because labor can last a long time, a thin catheter (tube) is usually threaded into your back to deliver continuous relief until the baby arrives.

The Benefits of an Epidural

The primary benefit is obvious: pain relief. By blocking nerve receptors, an epidural significantly decreases the intensity of contractions. This allows you to rest, relax, and stay present during the delivery.

However, the benefits go beyond just numbing the pain. Once you get an epidural, you may also experience a decrease in ⁽²⁾:

Fatigue (allowing you to sleep before pushing).
Irritability and stress hormones.
Panic or anxiety.
High blood pressure spikes caused by pain.

The Risks of an Epidural

While epidurals are generally safe, they are a medical intervention, and they come with risks. Knowing these ahead of time can help you prepare.

Common risks include:

Low Blood Pressure: This is the most common side effect. The medication can cause your blood pressure to drop, which may lower the baby’s heart rate. Your care team will monitor this closely and give you fluids to stabilize it.
Fever: Women with epidurals are more likely to develop a fever during labor. This can sometimes lead to the baby undergoing tests for infection after birth, even if they are healthy ⁽³⁾.
Prolonged Labor: An epidural can lengthen the second stage of labor (pushing) by roughly 15 minutes on average, because the urge to push is harder to feel. Reassuringly, that longer pushing stage does not by itself raise the risk of harm to you or the baby.
Instrumental Delivery: Because it is harder to feel where and when to push, there is a slightly higher chance of needing assistance from forceps or a vacuum extractor.
Back Pain: You might feel soreness at the injection site for a few days. However, long-term chronic back pain is typically not caused by epidurals, despite common myths ⁽⁴⁾.
Headaches: In rare cases (roughly 1 in 100 to 1 in 500), the needle punctures the dura (the spinal covering), causing a “spinal headache”. This is treatable but can be painful and linger for a few days.

Regarding C-sections: Historically, people feared epidurals caused C-sections. However, massive studies (like those from the Cochrane Library) have largely debunked this. Having an epidural does not significantly increase your risk of needing a C-section ⁽⁵⁾.

Trust your instincts. If something feels off during the procedure or labor, speak up immediately.

Side Effects of an Epidural

Aside from the medical risks, you might experience some annoying but temporary physical side effects:

Itching: Common if opioids are used in the epidural mix.
Shivering: Many women experience uncontrollable shaking or shivering.
Nausea or vomiting.
Difficulty urinating (a catheter is often placed to help empty the bladder).
Numbness or heavy legs, making movement difficult.

These effects generally wear off within a few hours of the medication stopping.

What Is a Natural Birth?

“Natural birth” is a common term for an unmedicated vaginal delivery. This means giving birth without pain medication, such as epidurals or opioids. Instead, the mother relies on breathing techniques, movement, water, massage, and mindset to cope with labor.

The Benefits of a Natural Birth

Why choose the unmedicated route? For many, it is about feeling connected to the process and maintaining bodily autonomy.

Here are the potential advantages ⁽⁶⁾:

Control & Awareness: You remain fully alert and in touch with every sensation. You know exactly when to push and can work instinctively with your body.
Freedom of Movement: Without numbness or IV poles, you can walk, squat, use a birthing ball, or change positions freely. Gravity is a great tool for speeding up labor.
Faster Recovery: Without heavy anesthesia leaving your system, many moms feel alert and ready to walk shortly after delivery. You also avoid the common side effects of epidurals like itching or grogginess.
Pushing Efficiency: Because you can feel the “ferguson reflex” (the body’s urge to push), unmedicated pushing stages are often shorter and more effective.
Setting Flexibility: You aren’t tied to a hospital bed. This opens the door for home births or birthing centers if you have a low-risk pregnancy.

The Disadvantages of a Natural Birth

The main drawback? The pain. Labor is intense, and without medication, you will feel the full force of every contraction. This can be exhausting and, for some, traumatic if they are not mentally prepared or supported.

Additionally, if you plan a birth outside of a hospital (like at home), you assume the risk of transport time if an emergency arises. If complications occur, such as the baby showing distress, you may need to transfer to a hospital for medical interventions ⁽⁷⁾.

If you choose this route, hiring a doula or having a strong support partner is highly recommended to help you cope with the intensity.

Epidural vs. Natural Birth: How to Choose

Choosing between an epidural and an unmedicated birth is personal. There is no award for suffering, and there is no shame in pain relief.

Ask yourself these questions to help guide your decision:

Is my pregnancy high-risk or low-risk? (High-risk often requires hospital monitoring).
What is my personal pain tolerance?
Do I want to be able to walk around during labor?
Does the idea of a needle in my spine cause me anxiety?
Do I have access to a doula to help with pain management techniques?
Does my hospital have 24/7 anesthesia support?
How do I typically handle stress and exhaustion?
If I plan to go natural, am I open to changing my mind if labor is prolonged?

Remember, you can write a birth plan, but birth is unpredictable. Being flexible is the best way to avoid disappointment.

Some hospitals have no anesthesiologist and no ability to get an epidural. There are other things that can be done that bridge the gap between an epidural and natural birth that you can talk to your doctor or midwife about if you want something other than an epidural or natural birth.

Editor's Note:

Caitlin Goodwin, MSN, RN, CNM

Other Birth Options

It isn’t just black and white. If you want to avoid an epidural but need some help, there are middle-ground options ⁽⁸⁾.

Nitrous Oxide (Laughing Gas): Inhaled through a mask during contractions. It doesn’t remove pain completely but creates a sense of detachment and relaxation. It clears your system instantly.
IV Pain Medication: Opioids (like Stadol or Fentanyl) can be given through an IV. They “take the edge off” and help you rest, though they can make you and the baby sleepy.
Sterile Water Injections: Tiny amounts of sterile water are injected under the skin of the lower back. It stings briefly but provides excellent relief for back labor.
Hydrotherapy: Laboring in a tub or shower. The warm water acts as a natural pain reliever and muscle relaxer.
TENS Unit: A device that sends small electrical pulses to pads on your back, distracting the nerves from pain signals.

Epidural vs. Natural Birth FAQs

Can You Feel the Baby Coming Out With an Epidural?

Yes, most women feel strong pressure but not sharp pain when the baby comes out with an epidural. It is often described as intense fullness or the urge to have a bowel movement. You will feel the baby move down the birth canal, while the burning stretch known as the “ring of fire” is usually numbed.

Is There Less Tearing Without an Epidural?

The evidence on tearing is mixed, with no clear winner. Some clinicians think feeling the tissues stretch helps you slow your pushing and avoid a severe tear, but large studies have not found a reliable difference in tearing rates between medicated and unmedicated births. Controlled, guided pushing tends to matter more than the epidural itself.

When Is It Too Late for an Epidural?

It is usually too late for an epidural once the baby’s head is crowning or you are pushing hard, because you have to sit still for placement. Dilation itself is not the cutoff: many women still get one at 8 or 9 centimeters. Most hospitals do want you in active labor, often around 4 centimeters or more, before placing it.

Can You Walk After an Epidural?

Usually not with a standard epidural, since it numbs your legs enough to make them too heavy and unsteady to stand safely. A lower-dose “walking epidural” (a combined spinal-epidural) can leave you some movement, but even then most hospitals keep you in bed for monitoring, and not every hospital offers it.

Does an Epidural Affect You Later in Life?

Lasting effects from an epidural are extremely rare. Short-term soreness at the injection site is common, but large, well-designed studies confirm epidurals do not cause chronic back pain years down the road; that later pain usually traces to pregnancy posture and hormone-driven ligament changes. The rarest severe complications, such as permanent injury or paralysis, are very unlikely; the Royal College of Anaesthetists estimates the overall risk of permanent harm from a labor epidural at somewhere between 1 in 80,000 and 1 in 320,000.

Is Labor Faster Without an Epidural?

Often yes, at least for the pushing stage. An epidural can lengthen the second stage of labor by roughly 15 minutes on average, because it dulls the natural urge to push. That said, for a mom who is exhausted and tense, the rest an epidural provides can help her body relax and dilate, so the earlier part of labor sometimes moves along faster.

Does Getting the Epidural Needle Hurt?

For most women the epidural needle is very manageable, not the ordeal it sounds like. The anesthesiologist first numbs your skin with a local anesthetic, which stings briefly like a bee sting. After that you mainly feel firm pressure in your back, not sharp pain, while the thin catheter is threaded into place.

Can I Change My Mind and Get an Epidural Later?

Yes, you can almost always change your mind and ask for an epidural later. Plenty of women plan an unmedicated birth, then request one once active labor intensifies. As long as you can hold still for a few minutes and the baby is not already crowning, your care team can usually place it.

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