How To: Hospital Birth ~ without the epidural

Making the right choice for your birthplace is essential to safety and a successful outcome, being where you feel secure and find the most confidence in your caregivers gives you freedom to do the hard work of labor and birth to the best of your abilities. To give birth for the first time to a beautiful baby girl she calls Olivia, my friend Mica chose a hospital as her birthplace and an OB as her care provider. Despite an epidural being central to the way birth is usually managed in a hospital setting, Mica wanted to give birth without it and she was wildly successful.

I asked her what was important to her about choosing the hospital and care provider she did.

"I used my existing OBGYN, but the reasons I selected her were that she was a female doctor who already had children and experienced birth. Also she was pro vaginal birth using cesaerean only if necessary for mother/baby survival. My OB operated out of a level 5 NICU hospital, which was comforting to me in the case of complications."

It is imperative to choose a care provider who shares your beliefs about birth and who practices in ways you are most comfortable with. There are excellent obstetricians out there who support natural vaginal birth, if that's your goal make it your mission to find one!

And why did you want to birth without analgesic pain releif?

"I am generally anti-drug because they dull your body's response and warning systems. Trying to "push" when you can't feel your muscles is ridiculous in concept and often leads to hemmorhoids and tears because you can't tell when your body should stop."

There are many reasons women are drawn to birthing unmedicated from connecting to 'rite of passage' emotions to practically protecting themselves and their babies physically. Aiming for the most gentle birth possible to maximize my instinctive efforts while minimizing birth injury and trauma was at the top of my list too.

Through your pregnancy how did you prepare for the process of birth?

I drank a lot of red raspberry leaf and blends of pregnancy tea. I also took 5W. I can't say whether these truly prepare the body or if it is a placebo effect, but I did feel like I was actively participating in preparing my body for birth. I also exercised through my pregnancy as much as possible. Side twists and strengthing your core help prepare your body to handle the extra weight of the baby. Kegels help the labial muscles respond to the birth. You would train for any other intense physical activity (Karate tournament or marathon) but people don't train for birth and their bodies aren't ready for that intense physical challenge.

I love how she planned for birth as an intense physical event, prepped her body with nutrition and exercise and prepared her mind at the same time. Consumption of extra vitamins and minerals is only good for you, liberal drinking of Red Raspberry Leaf tea helps tremendously in keeping you hydrated and full of vitamins A, B, C, calcium, iron and alkaloids to strengthen uterine muscles. There is some dissent over the correct way to work the pelvic floor and whether kegels offer benefit beyond sexual function to aid in birth but since learning Tupler's Perfect Pushing Technique I would encourage every woman to explore the relationship between her abdominal and vaginal muscles....duh it's all connected. Yup it's true! Yoga is excellent exercise to strengthen your abdominals, the only ab workout to stay away from through pregnancy and post-partum is the traditional sit-up.

Okay back to Mica.....

So how was it? Was it more difficult that you thought it would be, or easier? What was the most challenging and the easiest part for you?

"I think the birth was actually very easy. The contractions were not bad for me. I counted to 30 through each contraction. Sometimes I lost count. Sometimes I counted to 30 several times. But if youasked me how long the contraction was, I'd say "about 30 seconds." Mentally, I knew I could handle intense feelings as long as it was only for 30 seconds...even though it was a bit longer in reality.
The most difficult part was the actual birth, It doesn't hurt so much as the baby which was moving is now "stuck" and you have to pass it. As a new mom I hadn't experienced that feeling before and I really had to hold my breath and count to ten while pushing. After 4 pushes I was like "Wow I can't do this...the baby just doesn't fit!" but then my dr told me that the baby had already crowned and all I had to do was push once more to get the head out and guess what? I knew I could do one more push. So I did. It's amazing what you can do when you know it's only "one more" time. "

I am always facinated when I hear first-time mothers say 'you know it really was not that bad at all!" Usually those are the mothers who have used Hypnobirthing or taken Bradley classes, preparation really makes a difference! Every woman will react differently to the challenge of labor, for some it's about totally losing themselves and letting go while others like Mica find comfort in clinging to the rationality of numbers, being practical and pragmatic as they KNOW they can do it and just go ahead and DO IT! The mantras she chose of 'knowing she could handle anything for 30 seconds' and knowing she could do anything 'one more time' were so powerful and served her well. Explore yourself as you to prepare for the challenge of birth by reflecting on hard situations you've faced in the past and bravely facing any fears to get a hold on them in advance. Imagine yourself being consistent as you work through difficulty, think about what would encourage you while facing doubt and communicate this to your parter and birth attendants so they are prepared with the right tools to help you through.

So what would you tell another mother with the same goal to encourage her success?

"Well, my doctor said that the best deliveries occur when the mom wants to try vaginal, but accepts that a c-section might be necessary and authorizes the dr to "run the show." If you have your heart set on one course of action, you mentally set yourself up to panic when things don't go to plan. Very few mothers do back-up or risk planning and then they can't enjoy the miracle in process. The goal should be a healthy baby and as a mother, you do whatever means are necessary to ensure that can happen."

As important as it can be to cement your birth desires with preparation and planning, I agree that keeping a certain level of openness to however things play out is important in obtaining an optimum outcome. Life is crazy, and often throws you curve balls. The vast majority of the time spontaneous vaginal birth just happens. When there are special considerations with a mother or baby's health or when there is a disproportionate amount of pain or difficult fetal positioning or extreme fatigue there is a real need and appropriate place for interventions including medicinal pain releif. There is an excellent blend of optimizing conditions to let nature to do her magic and assisting medically when needed, and that is best directed by YOU Posh Mama. As the birthing woman you are in the ultimate position of authority and at some point that may include the decision to allow a birth professional to 'run the show'. This is where the careful vetting of your care provider comes into play. If you have chosen an OB who truly supports you and shares your beliefs about birth you will feel more confidence in agreeing to any interventions recommended and will feel truly supported if YOU end up being the one to request an intervention. It happens, here's the story of an amazingly posh mama who knew something was wrong and that her baby needed surgery to be born.

And if you decide in the moment that you need an epidural after all, there is NO SHAME in doing what you know is best for you! Your reason will be unlike anyone else's, here is the inspiring story of another mother who worked hard against the odds for a hospital VBAC and ended up with an epidural to appease her OB but ultimately triumphed in her successful vaginal birth.

Let's talk a bit more about pain preparation.

The sensations of birth are OVERWHELMING, the first time you feel it get serious you're like 'Are you kidding me, is this for REAL?' It's unbelievable how much power you house internally, dealing with it will be as different as each woman and her experience and expectations are.

A mother I attended as a doula was very confident through her pregnancy about birth, she had read Spiritual Midwifery cover to cover, taken childbirth education classes, had a good understanding of the physiology of birth and was very in touch with her own body. She had witnessed her cats giving birth to their kittens, even assisting in removing membranes off a freshly born feline face and often talked about her pets behavior during birth and imagined herself acting similarly in the throes of contractions. I loved that she had such an instinctive image of birth in her head and encouraged her positive expectations. But when her labor day came and it happened to her own human self, I saw her hit that wall of self-doubt as she verbalized how badly it hurt and that 'she was done with this and wanted an epidural'. I tried my best to be intuitive to her and determine if saying these things felt good to her and was part of her process or if she really was thinking about what it would entail to pack everything up and get to a hospital to actually get an epidural, as she was laboring in a small birthing center. On a hot Austin Friday afternoon the sunlight bounced off the guitars on the walls of the 'Music Room' and she paced back and forth much like a cat, going from the bed to the bathroom to the shower and back, in an out of body state saying she felt like she was on drugs without a pain relieving factor. Yup. It's all very surreal where time and space transcend and it's so overwhelming that in one way you feel like you are watching it all on a movie screen and in other ways you are so IN IT that nothing seems real outside of the churning inside your own body. Hearing her cries as they intensified made me worry that I hadn't done my job, that I had been like the worst doula ever and had not prepared her properly for dealing with birth if it gets truly painful. 'It's her experience, and she's working through it' I reminded myself as I watched her with respect and responded accordingly to her every request which were primarily for counter pressure on her lower back and assistance in and out of the shower. She did work through it, totally rocked it and birthed her baby brilliantly about an hour later.

If we hadn't been in that birthing center, but at a hospital with an eager anesthesiologist standing by would she have really wanted that needle in her back for drugged relief? We'll never know, but I do know that when it was me laboring in a hospital that was all I wanted.

So for the woman who chooses a hospital as her birthplace and is serious about birthing her baby without analgesic, how can she best prep for success?

Prepare by reading, taking classes, learning relaxation techniques, visualizing positive birth scenes, choosing personal mantras and carefully selecting emotional support people. Just your partner? Your partner and your mother or sister? Your whole family and your doula? Whoever they are you will need those who you find calming and comforting, people who love you, who love your baby, who understand how difficult birth can be and who will nurture you through it. Don't be alone! Unless you truly want it that way. For sure don't be surrounded by people who stress you out, make you uncomfortable or irritable. The people around you should be happy to nurture beyond emotionally but physically as well through massage, an incredibly useful tool in relieving pain and increasing natural endorphins.

It's important to understand the basic hospital procedures so you are aware of why it may be difficult for the staff to understand and comply with your wishes. Hospitals are in the business of relieving pain, and when hearing a laboring women getting guttural they are compelled by their practice to offer her relief. Understanding that nurses are truly not trying to sabatoge you but are only doing their job can give you not only compassion for their position but good strategy for communication. By say...hiring a doula! A doula who aims to make as good a friend possible of every nurse who comes on shift, communicating your birth plan and getting everyone on the same page in supporting your goals.

Make sure your care provider respects your rights and won't pull a Kingsdale on you. Talk in detail to your OB as much as you can in in your prenatal appointments to truly secure their support for your birth plan, practice communication and get comfortable with the person you're ultimately trusting with your life and child. Also, understand that even though your OB may agree to forgoing certain standard procedures, this may conflict with hospital policy. Make sure you reconcile these issues and arrange a plan for your OB to communicate with the hospital staff so there are fewer frustrations on the day you give birth. Get as familiar with L&D as you can, touring your hospital more than once and hanging back to try to talk to some of the nurses, getting comfortable with your birthing space and connecting with a potential familiar face.

To obtain an intervention-free birth in a place where interventions are standard procedure a birth plan is essential. Here's my moonshot list of requests for a hospital birth, PhD in Parenting lists 10 excellent questions to ask and The Feminist Breeder explores the roles of power and patriarchy in relation to the birth plan. While you're at it, go ahead and write birth plan A, B & C as recommended by the Prenatal Yoga center to think beyond your dream birth scene and put real thought into all the possibilities (yes even the scariest ones) so you are as prepared as possible.


The desire to birth 'naturally' in a less than natural setting can be a whole lot of work but it has and CAN be done! Seek out and demand the care you want and deserve! Thanks to Mica for sharing what worked for her and best of luck to YOU!

Do Your Own Thinking

Rather than let someone in a white coat and degree on the wall do it for you. 'But what makes you think you know more than a doctor???' I've been asked. Well.....I don't think I know more than a doctor exactly, but I do think I'm intelligent enough to understand the mechanics of birth (um, not rocket science folks) read up on common complications (hooray for the University of Google) and the methods different birth professionals use for responding to them. And sorry but when it comes to my own healthy body I definitely DO think I know more than some random doctor who sees me as a random patient and just another mark on the statistics chart, expecting the worst as fear of liability is her bottom line.

I'm a unique individual!! And so is my baby! The American hospital system and insurance companies may not think so, but we are and for both our sakes I demand to be treated that way. Which is exactly why I chose to birth outside of a hospital, in my own home when I was preparing for the birth of my twins.

A chemically induced forced early exit for my babies at 36 weeks? Really? A forced epidural? Really? Forced to give birth on an operating table? Really? Forced to stay on my back with my legs in stirrups? Really? The 'choice' between allowing a doctor's arm elbow deep into my uterus to grab my baby's feet and pull him out or major abdominal surgery to extract him from my body??? No, thanks. REALLY.

Those are the constraints of maternity care I found offered in local hospitals, simply matters of policy that were non-negotiable. It didn't matter that I was a third-time mother with a history of healthy, full-term, intervention-free vaginal births and was enthusiastic about managing labor without medication. Because I had two babies (perfectly healthy, Baby B a breech position) inside my belly we were labeled and put in the high risk box.

And why do the good doctors believe a twin pregnancy and a breech baby is so risky? Largely, based on the findings from The Term Breech Trial which said that cesarean birth has better outcomes than vaginal birth for breech infants. Never mind the thorough professional criticism of the study and it's own follow-up which negated the original findings, obstetricians continue to perform c-sections as a matter of practice for multiples and breech babies. It's quick, can be easily scheduled, surgeons perform the surgical procedures they are skilled at and most often there are good outcomes. Win-win for everyone right? Oh, except for the mother who was perfectly capable and willing to birth her own baby but is now recovering from surgery, and the baby who most likely needed NICU time as they were born before they were ready and missed out on the important life-supporting events that occur in the process of normal spontaneous birth. Allowing babies to grow to full-term and begin labor naturally with a mother who is an active participant in their birth also usually has good outcomes. But it can take a long time, and is cheap. Where's the efficiency and profits in that?

In many ways, the modern obstetrical birth scene is a machine. One I didn't want to be a cog in. So I *gasp* thought for myself and hired a Certified Nurse Midwife to attend us at home who was comfortable with the very normal scenario of twins and the very normal presentation of a breech. I mean, if I wanted modern decor for my home I wouldn't hire Rachel Ashwell would I? Same principle, if you need help with something in your life find someone to assist you who does what you want and does it WELL.

Midwives do normal vaginal birth VERY well. They can also do multiples and variations on normal birth presentations well. Searching on Gentlebirth.org and Midwifery Today gave me a lot of information and filled my notebook with questions for my own midwife. We talked about her experiences and training, how it compared to what I had read, and what she felt most confident with. She even brought out her midwifery textbooks and dirt-dove options with me. A birth attendant should absolutely be this willing and transparent with you, treating you with respect. If you ask detailed questions and are met with condescension, silence, or get answers that do not satisfy you should think about transferring care. Been there! When expecting my first baby and telling my OB I wanted a natural birth I got a 'Sure, we'll see how things go' said shortly through pursed lips. I should have ran. I didn't, and she wasn't on call the night my daughter was born and while I was thrilled to walk away with my beautiful baby girl I was less than thrilled with my experience with that OBGYN practice.

Expecting my second baby, I still hadn't made the leap of considering birthing outside of a hospital so I made an appointment with an OB who'd been recommended by a friend. A friend who loves her pitocin-induced and epidural-aided births, I should have known I probably wouldn't get support for natural methods but I was completely shocked when after hearing the details of my daughter's birth he replied that he would have c-sectioned her! Why??? 'Because that labor was too long' he said, it had been about 36 hours. It mattered less to him that my daughter had been born perfectly healthy and there were no major complications, he said because I labored so long with her he considered me high-risk. I instantly went cold with his words and from that practice, I did run.

I ran straight to the Austin Area Birthing Center, where I was appropriately assessed as a low-risk mother and went on to enjoy a great pregnancy ending in a productive and completely manageable labor with my son. He was born in less than 18 hours from when contractions began, about 4 hours after checking in.

With my twins, my perinatal doctor (who had previously been a practicing obstetrician) was wonderful in his honesty and forthrightness in discussing delivery technique, I truly did appreciate that. But I also knew those techniques were not right for my babies. Performing a full breech extraction on a second twin may have been his favorite thing to do and while I'm aware I'd lose a contest of education and medical expertise with him I knew enough to know that I did not need anyone to pull my baby out, I have a uterus that can push just perfectly.

I thanked him, said he gave me a lot to think about and focused on the positives from my experience at his practice and went out the door so grateful for my midwife, who was trained in the 'hands off' method for birthing breech babies that I knew was our best bet to have him born safely. Which he was.

Birth is personal, and should be treated that way. Cookie-cutter constraints do not serve mothers and babies best. Find the support you need and deserve, demand evidence based care and don't let anyone else do your thinking for you!

And this is why.....

those first few hours are SO important. In my 'moonshot' hospital birth request list, my desire for my baby to stay in MY ARMS ONLY has good reason behind it.

The Magical Hour

The health benefits from the intense connection of the birth bond between mother and child are far more important than heel pricks, blood tests, vaccines, weight & length measurements, cord cutting and even cleaning. All of that can wait, if it's to be done at all. The healthiest thing for a baby is it's mother. The safest place, it's mother's loving arms. Especially for babies in distress, or fighting death.

Common practice calls for newborn babes to be whisked away, placed under hot lights for warmth when their mother's empty arms could provide that needed heat so much more effectively, held close to her heart.

Why? Ask that question Posh Mama! If the answer is unsatisfactory, demand your baby stay with you!

If I were going to give birth in a hospital

my moonshot list of care to request and decline would look like this....


*minimal u/s scans through pregnancy

*no induction before 42 weeks (unless evidence of fetal distress)

*no epidural

*ability to move freely

*privacy, minimal staff in attendance

*control of room lighting

*no cervical checks

*no heparin lock

*fetal monitoring with doppler only

*wear my own clothes

*have my own food & drinks

*no time constraints

*birthing ball, birthing stool

*room with a bathtub and slower

*allow waters to break naturally

*freedom to choose birthing position

*freedom for my husband or I to catch our own baby if desired

*delayed cord cutting

*keep placenta

*baby in my arms only for first few hours unless I request assistance

*spontaneous birth of placenta

*baby's own clothes and blankets

*lactation consultant, breastpump

*place for father to room in

*baby stays with me, no nursery visits

*no circumcision

*NO BOTTLES

*early discharge


Okay, so I know much of what I listed is totally against most hospital policy and would be impossible to get but like I said it's shooting for the moon. Why not?

The most important thing when negotiating for evidence-based care with an obstetrician and L&D nurses is to be calm, kind and gracious. It is a hard thing to ask people to do their job differently, or to not do it at all. Most doctors and nurses are wonderful people who love mothers and babies and the last thing you want is to create a struggle or be in a place where you feel like you are having to 'fight'. At least for me, birth is all about being soft and open, letting go and trusting. It is not the time to have to direct your energy toward controlling others. This is where having a doula for support, and working with your OB far in advance on your desires for care during birth can be extremely helpful in having everyone in agreement and on the same page.

Taking the hospital tour and hanging back afterward to chat with the nurses and ask questions can be extremely helpful too. You never know who will be on shift when you go into labor, but the chance that you could make a connection is worth it. Getting more familiar with what will be your birthing space will only help your comfort and boost your confidence.

What am I missing from my list Posh Mama's? What made your hospital birth a success, or what did you learn from a frustrating experience you would like to pass on to others? What negotiating tactics worked for you in obtaining a natural birth in a hospital setting?