If you are hoping to avoid an epidural
In the one study that followed the intention through, 57% of women who hoped to avoid an epidural had one, and 91% of those who planned one got it.
This topic is not here to talk you out of anything. It is here so that whatever happens does not arrive as a verdict on you.
The one hard figure. A study followed 303 first-time mothers who had attended childbirth classes and had said in advance what they wanted. Of the 185 who planned to have an epidural, 91% had one. Of the 110 who hoped to avoid one, 57% had one. So fewer than half of the women who hoped to avoid an epidural avoided it. That is one American city, in the 1990s, among women who went to classes, which is a group more committed than average to going without. It is still the best number anyone has.
An older study found something similar in a different way: among first-time mothers who had done prepared childbirth training, 81% went on to request an epidural.
Now the counterweight, and it matters. A prospective English study of over 700 women found the opposite of a trap: Women who preferred to avoid drugs were more likely to do so, and were more satisfied with the birth overall than women who used drugs.
Wanting an unmedicated birth is not a setup for disappointment. What the evidence points at is unprepared expectations, not ambitious ones.
What is actually measured about pressure. In a survey of 2,400 American mothers, 15% said they felt pressure from a health professional to have an epidural. The interesting part is the direction: pressure was reported by 19% of the women who did not have one and 13% of those who did. For induction and for cesarean the pattern ran the other way, with pressure reported far more often by the women who had the procedure. On the epidural, the women who most often reported being pushed were the women who said no.
What is not measured at all. How many women feel that they failed. There is no survey figure for guilt, self-blame or a sense of personal failure after an intended unmedicated birth ended with an epidural. What exists is small: interview studies of 14 women in France and 14 in Denmark, focus groups with 46 women in England, and a comparison of 47 women in which those who asked for an epidural had significantly lower pain scores and were nonetheless less satisfied as a group, which the authors attributed partly to what they called the perceived failure of requesting an epidural
. That is a direction from 47 women, not a rate. Anyone who quotes you a percentage for how many women feel like a failure is making it up.
The French interview study opens with the shape of it: An increasing number of women are seeking a more physiological birth, opting to give birth without epidural analgesia. However, most of them ultimately opt for it.
The decision moves during labor, shaped by how tired you are, how supported you feel, and how long it has been.
Control is not the same as going without. In a study of 1,146 women, 61.0% felt in control of their own behavior in labor and 39.5% felt in control of what staff did to them. About one fifth felt in control in all three ways measured, and about one fifth in none of them. The first half of this stage covers why that matters more for how you look back than the mode of birth does.
"If I say I want to keep going, please help me keep going, and ask me again in an hour."
"Please do not tell me afterwards that I did or did not do well. Just tell me what happened."