Ways to Avoid Medication During Labor



What advance arrangements should I make?


How can I maximize the chances of having an unmedicated birth once I get into labor?

How can those accompanying me in labor help me make choices about pain relief that I will be happy with in the long term?




What advance arrangements should I make?

In hospitals where epidural use is the norm, limited options tend to be available for women planning to rely on comfort measures and mental strategies. You will want a hospital that provides comfort measures (showers, rocking chairs, etc.), has policies that don't inhibit their use (freedom to be up and around in labor, no routine IV, etc.), offers sterile water injections for low back pain, and has nurses that know how to help laboring women who don't have epidural analgesia. You may also wish to consider birth in a free-standing birth center or at home so that non-drug methods will be the primary or only option.

To cover the possibility of needing to go to "Plan B," you may wish to investigate the options for pain medications at your hospital or, if you have decided on an out-of-hospital birth, at your back-up hospital. (This website has a full section to help you learn about your options and choose a birth setting.)

You may want to seek a maternity caregiver or group practice that is comfortable with your preferences and has lots of experience helping other women have unmedicated births. (This website has a full section to help you learn about your options and choose a maternity caregiver.)

If you will be in the hospital, a doula or other experienced provider of labor support can help you avoid pain medications and work with other methods. At a home birth or free-standing birth center, the midwife, midwife's assistant, or nurse may take on this role, and you may also want to consider a doula. (This website has a full section to help you get the labor support you need.)



How can I maximize the chances of having an unmedicated birth once I get into labor?

  • ask everyone on your birth team (including any companions who came with you and the nurses) not to promote pain medication; if you feel that you are far from needing medication, turn down an anesthesiology consult that may be offered; any promotion of pain medication may undercut your self-confidence
  • if you have low back pain that is difficult to manage, consider sterile water injections
  • let your key support people know how you would communicate a clear wish to move toward using medication, such as a specific phrase for this situation only; this will help them understand when your expressions of discomfort call for support and for trying other comfort measures or mental strategies and when you might truly be ready to move to medication
  • if you feel close to needing medication, waiting for a fixed period before setting anything into motion may help you get through a difficult time
  • if you feel close to needing medication, a check on your cervical dilation may show that you are close to the time of pushing and birth
  • if you are nearing the time to push, you should recognize that pain sources and sensations in the pushing phase of labor are different from those in the dilation phase; pushing may be much more bearable.

How can those accompanying me in labor help me make choices about pain relief that I will be happy with in the long term?


If you are wondering whether to use medications, you and your team should consider
  • whether you felt strongly about avoiding pain medication before labor, and would appreciate continued help from your labor team with this path
  • whether having medications is your idea or you are being pressured subtly or overtly by others
  • how close you are to giving birth, and what medication options are open to you at the time
  • whether you have more stamina or are becoming exhausted
  • whether changing the tone in the environment can help you stay on the drug-free path
  • whether your support team has other drug-free measures to try.
If you entered labor with a wish to avoid pain medication, remember that while commitment, preparation, and good support are important to achieving your goal, everyone has an "enough" point. You may reach yours. Knowing in advance the trade-offs of the various pain medications will help you make a good decision for yourself should that time come. (See Options: Labor Pain, Best Evidence: Labor Pain, and Using Medication in Tips & Tools for discussions of working with medication.)

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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.
Most recent page update: 11/16/2012