As your due date nears, you’ll likely have many of the details of your baby’s birth hammered out. But a big decision might still be keeping you up at night: Should you use pain medications during labor or go unmedicated?

There are pros and cons to each method that you should discuss with your healthcare provider. The good news is that there are plenty of options for pain relief during labor. The choice is ultimately up to you.

Making the choice not to use medication doesn’t mean the birth process has to be incredibly painful.

Complementary methods are often used in birthing centers or at home with a midwife, but they can certainly also be used at a hospital.

The greatest benefit to unmedicated childbirth is the lack of side effects from medications. While many pregnant people can take pain medications safely during labor, there is the risk of side effects for both mom and baby.

Plus, with unmedicated births, a birthing person’s own hormones can naturally help labor progress steadily and without intervention. Released endorphins during the birth process can provide pain relief and promote bonding and breastfeeding (if you like!) after baby is born. Medications can often interfere with this hormone release.

The downside to unmedicated labor is that you don’t know for sure how painful the process will be (especially for first-time parents). In some cases, the pain might be worse than anticipated. In other cases, people find labor to be far more manageable than they were expecting.

Medication-free pain management options can come in the form of breathing techniques, complementary therapies, and physical interventions.

Being mindful of the breath helps you increase awareness of sensations in your body. This can help you be more aware of contractions during delivery to prevent complications.

Breathing is also a relaxation tool that can help you keep calm, especially as the intensity of labor increases.

Breathing techniques during childbirth aren’t as dramatic as often portrayed in movies and on TV. The key is to take deep breaths.

Saying light mantras or honing in on images through mini meditations can complement breathing techniques to make labor more comfortable. Hypnosis is another viable option that helps many people cope better with the intensity of labor.

Aside from breathing techniques and light meditation, other therapeutic techniques can help create a relaxing environment with reduced pain. You can ask for:

  • sterilized water injections in the lower back
  • massages
  • acupuncture or acupressure
  • yoga

Sometimes breathing techniques and complementary therapies aren’t enough to alleviate labor pains.

But before you request an epidural, you might try other techniques that work physically with your body. The options include:

  • asking your nurse, , doula, or partner to help you change your position, which can help distract your mind from pain related to contractions
  • sitting or laying down on a birthing/labor ball (similar to a stability ball)
  • taking a bath or shower
  • using ice or heat pads on your back
  • walking, swaying, or dancing

If you prefer a near-guarantee of reduced pain during labor, you’ll want to consider medication options. It’s best to talk about these with your doctor or midwife ahead of time.

You’ll also want to find out if certain medications are appropriate for you based on your health history.

The obvious pro to medications for labor is the pain relief. While you may still feel dull sensations during contractions, most of the process is virtually pain-free. The downside is that pain medications always carry a risk of side effects.

These can include:

  • drowsiness
  • headaches
  • nausea
  • vomiting
  • low blood pressure
  • itchy skin
  • urinating difficulties
  • not every pain medication works for every person
  • slowed labor progress

Pain medications may be transmitted to the baby, though this varies by medication type. Transmission may cause side effects in the baby, such as difficulty breathing after birth or difficulty breastfeeding.

The most common forms of pain medications for labor include:

Epidural

An is a type of local anesthesia that’s administered through the lower back. Pain is alleviated from the waist down in both vaginal and cesarean deliveries.

The benefit of an epidural is that the amount may be decreased or increased, as needed. If you think you need more pain relief via your epidural during your labor, speak up!

Pain relief from epidural and spinal anesthesia aren’t passed through the placenta to the fetus, whereas intravenous (IV) analgesics and general anesthetics are.

A downside to an epidural is that once it’s been placed, you’re going to be confined to your hospital bed — with numb legs — for the duration of your labor.

Spinal block

A spinal block is similar to an epidural, but the medication is short-lasting (only an hour or so).

Analgesics

These come in form of shots or IVs. Analgesics affect the entire body, and are more likely to impact the baby.

General anesthesia

Medication that puts you completely to sleep. This is not typically used during or deliveries. It’s only used in true emergency situations.

Tranquilizers

Tranquilizers are often used alongside analgesics, and these medications are used for relaxation during extreme anxiety. Due to a high risk of side effects, tranquilizers aren’t normally preferred except for in extreme cases.

While it’s important to get all of the necessary facts you need to make a decision about childbirth, the choice is up to you. Only you can determine what is best for you during labor and what is best for your baby.

It’s easy to become persuaded by horror stories from either side. Try your best to stick to the facts related to all of the options so you can make the most informed decision possible.

It’s also important that you discuss your decision with your midwife or doctor ahead of time. Not only will they be able to provide tips for both unmedicated methods and pain medications, but you also don’t want to surprise them on delivery day.

If you are planning an unmedicated labor, it’s also important to make sure you choose a provider and facility that truly support your choice.

In addition, there are ways you can alleviate pain before you go into labor. Exercising throughout pregnancy strengthens the body, and can increase your pain tolerance. Childbirth classes (such as Lamaze) can also give you tips to better prepare for your due date.

Make sure everyone involved with your child birth process knows your plan so they can stick with it. To avoid confusion, always put your childbirth wishes in writing. It’s OK to change your mind one way or the other!