Unmedicated birth can offer many benefits, but it also involves real challenges that need preparation, planning, and support. In this episode, you’ll discover why some parents choose an unmedicated birth and what a physiologic birth without interventions looks like. Discover practical strategies to help you prepare for an unmedicated labor, if that’s the route you choose, and learn about the most common mistakes parents make when preparing for this approach. Whether you are curious about an unmedicated birth or know you want an epidural or other pain management options, understanding how the natural birth process works can help you make more informed decisions, maximize the benefits of interventions, and approach birth with confidence.

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Defining Natural Birth

The term “natural childbirth” was introduced in the 1930s by obstetrician Grantly Dick-Read in his book Natural Childbirth. He defined natural birth as birth with the absence of any intervention that would otherwise disturb the labor sequence. Dick-Read later published Birth without Fear, which is still in print and widely read today. His view was that fear causes tension, which increases pain, and he strongly advocated for birthing without interventions.

The Negative Stigma of Natural Birth

Some critics argue that all births are natural and that using pain medication or other interventions does not make a birth “unnatural.” The New York Times has pointed out that there is no single, universal definition of natural birth, and the term itself can make some parents feel judged or shamed if their experience does not fit that label. In this episode, we define natural birth as birth without pain medication and with little to no interventions. It is important to remember that birth is not a black-and-white choice between having a baby without any interventions at home or needing an emergency cesarean in a hospital. There is a wide range of options and interventions that may support you during labor, and we are fortunate to have access to these tools when they are needed.

Understanding Pain in Labor and Birth

Choosing an unmedicated birth does not mean rejecting the medical advances that are available today. A common comparison is, “You would not go to the dentist and have them work on your teeth without anesthesia, so why give birth without it?” The reality is that labor is more complex than simply deciding whether or not to feel pain. The experience of birth involves physical, emotional, and hormonal processes that go far beyond discomfort alone. If you would like to explore this further, consider reading this article on reframing your perspective on labor pain.

Reasons Parents Choose Unmedicated Birth

The trend of unmedicated births grew in the 60s and 70s, with hippies choosing to have babies outside of the typical medical model. Today, the list of people opting to have a natural birth is growing every year. Many celebrities who have all the resources of money and medical care available chose to forgo a typical hospital birth with an epidural and have a birth without interventions. Some of the women on this list include Kate Middleton, Mila Kunis, Cindy Crawford, Gisele Bündchen, Demi Moore, and Beyoncé.

There are many reasons parents may want an unmedicated birth. For some, it is about allowing the physiologic process of labor to unfold without interference. Others want to avoid the potential side effects or risks associated with pain medication and interventions. Some parents believe in the hormonal and emotional benefits of unmedicated birth support, bonding, and breastfeeding. Cultural or spiritual beliefs may also play a role.

Birth as a Natural Physiologic Process

Supporters of unmedicated birth often point out that people have been giving birth without interventions for thousands of years. Birth is, at its core, a natural physiologic process. Our bodies are built for it, and the survival of our species depends on it. While modern science continues to expand our understanding of how labor works, especially the role hormones play, there is still much we do not fully understand. Viewing birth through the lens as a natural physiological process helps explain why many parents choose to allow this process to unfold with minimal disruption.

Your Baby’s Development in the Final Weeks

The last few weeks of pregnancy are critical for your baby’s development. During this time, you pass maternal antibodies that help protect your baby from infections in their first days and weeks of life. Your baby gains weight and strength, increases iron stores, and develops more coordinated sucking and swallowing abilities. Their lungs mature and prepare for that very first breath of air. In addition, your baby stores brown fat, which will help them maintain their body temperature after birth.

How Your Body Prepares for Labor

As your baby is maturing and getting ready for birth, your body is also preparing for labor. Your placenta releases prostaglandins that soften the cervix and prepare it to efface and dilate. Rising estrogen levels and decreasing progesterone levels make the uterus more sensitive to oxytocin, the hormone that drives contractions. As labor approaches, your baby also moves lower into the pelvis.

Alongside these internal changes, you may notice external signs too. Many parents experience a burst of energy that helps with last-minute preparations, or trouble sleeping, which may serve as nature’s way of preparing you for the sleepless nights ahead with a newborn. All of these shifts work together in harmony, allowing labor to start naturally when both you and your baby are ready.

Oxytocin’s Role in Labor

Oxytocin plays a vital role throughout pregnancy and birth. During your pregnancy, oxytocin is a hormone that helps your body absorb nutrients more efficiently, reduces stress, and promotes energy conservation by inducing sleepiness. During labor and birth, oxytocin is the driving force of your contractions. You need a steady flow of this hormone to keep labor progressing.

It is not a coincidence that oxytocin is also released during orgasm, earning it the nickname “the love hormone.” Many birth educators point out that the environment you give birth in should feel as safe and comfortable as the environment where you make love. When you feel secure and relaxed, your body can produce oxytocin more freely. In nature, animals retreat to quiet, private spaces to give birth. If danger appears, their labor may stop until they feel safe again. Humans respond in much the same way.

For some parents, the safest place might be at home or a birth center; for others, it could be in a hospital. You can have an unmedicated birth in any setting, and there are many ways to optimize your birth environment, such as dimming lights, playing calming music, or limiting interruptions, to help create an atmosphere where oxytocin can flow and labor can progress.

Beta-Endorphins and Pain Relief

In the first stage of labor, as your cervix dilates and effaces, your body releases a beta-endorphin hormone that acts as an opiate or pain reliever. This is a stress hormone produced under duress. The synthetic drug morphine works similarly to beta-endorphin. It also suppresses the immune system, which is believed to be important in preventing your immune system from attacking your baby, who has a different genetic makeup from you.

During labor, high levels of beta-endorphins are released, which can reduce oxytocin levels and slow down contractions. While this might seem counterproductive to birth, it actually helps you experience the positive effects and relief from beta-endorphins, and keep labor at a pace where your body can handle the stress. Beta-endorphins do more than just dull pain; they also induce feelings of calm, pleasure, and even euphoria. Many people describe this as entering “labor land,” a state where you tune out your surroundings and focus inward on your body and your baby.

Hormones During the Pushing Stage

At the end of the first stage of labor, your cervix is fully dilated at 10 centimeters, and you enter the transition phase, which takes you into the second or pushing stage of labor. This is where your fight-or-flight hormones come in, which are classified as catecholamines. These include adrenaline (epinephrine) and noradrenaline (norepinephrine). Your adrenal glands release them in response to stress, and while they can slow labor in the first stage, they act very differently just before birth.

Right before your baby is born, catecholamine levels surge, especially noradrenaline. This works with oxytocin to trigger the fetal ejection reflex. These are powerful contractions that push your baby out quickly. You may feel a sudden rush of energy, become alert, notice a dry mouth, and breathe more rapidly. Some people describe emotions like fear, excitement, or intensity in this moment. These hormones also protect your baby. When your uterus contracts, blood and oxygen flow temporarily decrease. Catecholamines help your baby tolerate that stress. After birth, your levels drop sharply, which allows oxytocin to rise again and support bonding and recovery.

Hormones After Your Baby is Born

Once your baby is born, you enter the third stage of labor, where oxytocin continues to be released, which will keep contractions going. These contractions will be milder than the ones you experienced during birth. The purpose of the ongoing contractions is to push the placenta out of your uterus, close off the blood vessels attached to it, and start shrinking your uterus. This process is essential to prevent postpartum hemorrhage, heavy bleeding, and other serious complications. 

How Hormones Affect Your Baby

The hormonal changes you experience during labor also affect your baby. Right after birth, both you and your baby have high levels of oxytocin, which promotes bonding. At the same time, the surge of fight-or-flight hormones helps your baby stay alert for those first important moments of connection. Skin-to-skin contact then helps calm your baby, lowering adrenaline and noradrenaline levels, and easing the transition from the womb to the outside world.

Hormones and the First Breastfeeding Latch

One of the first things that happens after birth is your baby’s instinct to breastfeed. If a newborn is placed on your abdomen, they will use all of their senses (sight, touch, taste, smell, and sound) to instinctively crawl toward your breast and latch. This phenomenon is known as the breast crawl. Babies are born wired to breastfeed, and hormones play a significant role in helping your body produce milk and in shaping the breastfeeding relationship.

The hormone most closely linked to breastfeeding is prolactin, often called the “mothering hormone.” Prolactin levels are elevated throughout pregnancy, but milk production is held back until the placenta is delivered. After birth, prolactin peaks, supporting milk production and encouraging nurturing behaviors between you and your baby. Oxytocin is also critical, triggering the let-down reflex that releases colostrum and signals your body to continue producing milk. About 20 minutes after birth, beta-endorphin levels peak as well. These hormones not only contribute to bonding but also pass into your colostrum, helping foster a sense of dependency between you and your baby.

How Interventions Affect the Birth Process

Labor and birth are complex processes with many moving parts. While our understanding of physiologic birth continues to improve, we still do not fully know how every intervention influences the cascade of hormones that drive labor. Interventions can be incredibly valuable in helping parents who encounter complications and, in some cases, saving lives. Along with benefits, every intervention carries some level of risk, which is why some parents prefer to avoid them unless absolutely necessary. It is also important to remember that interventions rarely happen in isolation. One procedure often leads to another. For example, choosing an epidural typically also means receiving IV fluids and continuous electronic fetal monitoring. This makes it difficult to separate the effects of one specific intervention from the combined impact of several.

While this episode focuses on an unmedicated birth with little to no interventions, you can explore other episodes of the Pregnancy Podcast that explore the evidence and details for each intervention:

• Your Options for the Third Stage of Labor
• The Evidence on Ultrasounds
• Birth Interventions Overview
• The Evidence on Vaginal Exams Before and During Labor
• What Every Mom Needs to Know About Group B Strep (Antibiotics)
• Evidence on the Risks and Benefits of Inducing Labor
• Electronic Fetal Monitoring
• The Evidence on Eating and Drinking During Labor (IV Fluids)
• Epidural
• Nitrous Oxide During Labor
• Other Pain Management Options During Labor
• Vaginal Tears and Episiotomy: Prevention and Healing
• What to Expect in a Cesarean Birth
• Options To Make a Cesarean More Mom- And Baby-Friendly

Planning for an Unmedicated Birth

One of the biggest mistakes I see expecting parents make is approaching labor with the idea that they will “try” for an unmedicated birth, but plan to request an epidural if it becomes too difficult. While there is nothing wrong with choosing an epidural, this strategy does not set you up for success if your real goal is to avoid interventions. Labor, especially with a first baby, is often far more intense than most parents anticipate. Simply trying to power through contractions without preparation or coping tools is rarely effective.

With an unmedicated birth, you take on the responsibility of managing your labor without the help of pain medication. That means you will need plenty of tools and strategies to support you along the way. Preparation is key, and the more you learn and practice ahead of time, the more likely you are to have the birth experience you want. There are many different tools and techniques you can explore, from physical positions to mental strategies. Ideally, you take a birth class focused on an unmedicated birth. Here are some episodes of the Pregnancy Podcast with tools you can add to your labor and birth toolbox:

Understanding Labor and Birth

• Navigating Each Stage of Labor and Birth
• What is Pasmo, and How Can You Avoid It?
• Natural Hospital Birth

Tools and Comfort Measures

• Can Eating Dates Naturally Induce Labor and Shorten Duration?
• Do You Really Need a Doula?
• Tools and Techniques for an Easier Labor and Birth
• Optimal Labor Positions for a Shorter and Easier Birth
• Vaginal Tears and Episiotomy Prevention and Healing
• Optimizing Your Birth Environment for a Better Labor Experience
• Breathing During Labor
• Hypnobirthing
• Hydrotherapy and the Benefits of Water During Labor (Baths, Showers, and Waterbirth)
• Using a TENS Machine During Labor
• Using a Rebozo in Pregnancy and Birth

Mindset and Emotional Preparation

• Q&A: Managing Your Fear of Labor Pain
• Overcoming Fear and Anxiety to Go into Birth with Confidence
• Fear of Things Not Going as Planned
• Preparing Your Partner for Birth

Challenges of Unmedicated Birth

While there are many benefits to an unmedicated birth, it is also essential to acknowledge the challenges. Choosing to labor without pain medication often means experiencing intense sensations for an extended period of time, especially if labor is prolonged. Without adequate support or coping tools, this can increase stress and fatigue, which may affect both you and your baby.

Even with thorough preparation, birth does not always go according to plan. Situations can arise where interventions become necessary, such as labor that is not progressing, signs of distress in your baby, or complications that cannot be managed without medical assistance.

Some parents also find that despite their best efforts, the intensity of labor becomes overwhelming, and they choose to use pain relief. These possibilities do not mean you should avoid an unmedicated birth if it is what you want. Instead, they highlight the importance of flexibility, preparation, and surrounding yourself with strong support. Knowing that challenges can arise allows you to plan, adjust expectations if needed, and still feel empowered in your choices.

The Importance of Labor Support

Having strong physical and emotional support during labor can make a huge difference. Whether it is your partner, a friend, or a family member, the more involved they are during pregnancy, the more effective their support will be. Including them in your birth class and prenatal appointments helps them understand what to expect and how best to assist you when you are in labor.

The Role of a Doula

If you plan an unmedicated birth, hiring a doula is one of the most effective steps you can take. A large review of studies involving over 15,000 women found that continuous support during labor significantly improved outcomes. Having a doula increases the likelihood of a spontaneous vaginal birth, reduces the need for pain medication, lowers the risk of cesarean or instrumental delivery, and can shorten labor. For more on what doulas do and how they support parents, check out this episode.

Partnering with Your Care Provider

Your doctor or midwife is also a critical part of your support system. Ideally, you will be working with someone experienced in unmedicated birth who can help you navigate challenges without defaulting to interventions. Throughout pregnancy, take time in your prenatal appointments to discuss your preferences and make sure you and your provider are aligned. That way, when you go into labor, you can work together toward the birth experience you want.

Of course, not every parent has equal access to a doula, midwife, or out-of-hospital birth setting. Cost, geography, and availability can all limit these options. That does not mean you cannot still plan for a positive, supported experience. Even if your choices feel more limited, there are many ways to prepare, build a strong support system with the resources you have, and work with your provider to create the best birth environment possible.

How to Use the BRAIN Framework

No matter how much you prepare, labor and birth will always include some unpredictability. That is why it is essential to learn about common interventions, even if you hope to avoid them. If your provider recommends an intervention, or if you decide you want something like an epidural, it is helpful to be educated ahead of time. There is a fantastic framework to evaluate your options for an intervention using five simple questions. You can remember these by using the acronym BRAIN.

• Benefits: What are the benefits?
• Risks: What are the risks?
• Alternatives: What are the alternatives?
• Intuition: What does your intuition tell you?
• Nothing: What happens if you do nothing?

If you need to make a decision for an intervention during labor, walking through these questions will give you a clearer picture of the pros and cons and support you in making the best decision for yourself and your baby.

Creating a Birth Plan and Backup Plan

Writing a birth plan is a valuable way to start meaningful conversations with your care provider and clarify your preferences. Simply handing over a typed sheet during labor will not guarantee the birth experience you want. The real value lies in the preparation and discussing your wishes with your partner and care provider ahead of time so everyone is on the same page.

For example, if you prefer not to have active management of the third stage of labor, it is essential to know whether your provider supports this choice. Some providers routinely use Pitocin during this stage, so it is essential to work through any differences early rather than trying to negotiate while delivering your placenta.

It is also wise to create a backup plan. Even if you plan for an unmedicated birth, circumstances may shift, and having a secondary plan ensures you still feel prepared and supported if things do not go as expected.

The Pregnancy Podcast has many resources to help you craft a birth plan:

• Guide to Creating Your Birth Plan
• Get a copy of Vanessa’s birth plan
• Your Birth Plan book
• Become a Premium Member for a FREE copy of the Your Birth Plan book and access to every single episode ad-free

Preparing for Labor Challenges

Labor can be a marathon, and you never know exactly how long it will last. Exhaustion and lack of sleep are common challenges, and they are a frequent reason why parents who plan for an unmedicated birth end up requesting an epidural. One of the best things you can do is start labor well-rested. If you notice early signs of labor and can sleep, take advantage of the opportunity. Even a short nap during the day can pay off hours later. The same goes for your partner. If they plan to support you through the entire process, their rest is just as important.

Your mindset is also a powerful tool. Labor becomes more challenging as it progresses, and having strategies to reframe pain can help. Focusing on your reasons for choosing the birth you want and keeping your attention on the moment you will meet your baby can provide motivation. This article on reframing how you think about labor pain may also be helpful.

Finally, be mindful of the stories you surround yourself with. Positive birth stories can build confidence and encourage a healthy outlook, while horror stories or negative experiences can plant seeds of doubt and fear. Seek out uplifting accounts of parents who felt strong and capable through their birth experiences to help you enter labor with a positive mindset.

Additional Resources

If you want to dive deeper into physiologic birth, there are some excellent resources available. One is the documentary The Business of Being Born, produced by Ricki Lake, which highlights statistics and comparisons between physiologic and medicated birth. While the film strongly advocates for “natural” birth, it raises important points worth considering. You can rent it on Amazon. Another valuable resource is Ina May’s Guide to Childbirth. This book combines evidence-based information with real birth stories, offering both practical guidance and inspiration for parents planning an unmedicated birth.

Remember: You Always Have Choices

The most important thing to keep in mind is that you always have choices. Birth is not limited to extremes of either having your baby at home in a bathtub or having an emergency cesarean in a hospital. There are countless options in between, and you can combine the tools, techniques, and procedures that feel right for you. Your birth experience is yours to shape, and you can make decisions along the way that best support you and your baby.

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