What do you think? After teaching natural childbirth classes for twenty-four years, I’ve learned that natural birth means different things to different people. Was my four hour Pitocin induced labor a natural birth, because I had no pain medications? Or only my two hour homebirth which my midwives barely made? I once asked my natural childbirth students what natural birth meant; the consensus was anything short of an epidural, including other pain medications, was natural birth. So I’ve come to see it as a continuum.

On one end are homebirths like the ones I was lucky to attend when I was a midwifery apprentice in the early 1990s. Michel Odent calls them undisturbed births. The mother is in her home, and she runs the show. She eats and drinks what and when she wants, is along or surrounded by people she knows well and has invited, walks or rests, moans, complains, sings, or is silent, gets in her tub if she wants. The baby is born and goes directly on mom’s chest with the cord attached. There is no small talk. It is all mamababy time. There are no bright lights, no unnecessary questions or exams, no separation.

The spectrum of natural childbirth, according to many, seems also to include inductions, analgesics, IVs, ruptured membranes, almost anything except an epidural. I don’t feel it’s for me, or anyone, to label another woman’s birth experiences. I love what Joyce Maynard says about her birth experiences. “Before I had children I always wondered whether their births would be, for me, like the ultimate in gym class failures. And I discovered instead…that I’d finally found my sport.” Natural birth can be about discovering what our bodies can do.

I asked readers of my WellPregnancy Facebook page why they birthed naturally. One mom posted, “I didn’t want to experience drug side effects and I didn’t want my baby to experience those side effects. There wasn’t time for drugs and I trusted my body and my baby.” Another remembered, “I didn’t get a natural experience the first time, and that left me feeling disappointed. I gave birth naturally because I knew my body could, and in the end it was the most empowering feeling I have ever had!” And a third shared, “After having an epidural with my first birth, I felt like I had totally lost control over myself and the process. I felt that the process was meant to be honored. So my second and third births were natural, unmedicated. I had control back. I was able to feel what my body was capable of doing. And it was amazing and empowering!!”

As a culture we believe that pain is unacceptable. But when we numb out sensation in labor, we diminish our endorphin levels and the endorphin levels of our babies. The pain is dulled, but so is the exuberance we are meant to experience afterwards, when contractions are over and mother and baby bathe in the highest endorphin levels, higher than what marathoners get. Martha Beck captures it when she wrote, “Anyone who has felt the pain of bearing a child, or pushed past physical limits in some athletic event, or struggled to learn difficult but powerful truths understands that suffering can be an integral part of the most profound joy. In fact, once suffering has ended, having experienced it seems to magnify the capacity… to feel pleasure and delight.”

Because endorphins are released in spurts during labor in the brains of the mother and baby along with oxytocin, when the endorphin levels are tampered with due to the use of pain medication, oxytocin is also reduced. Oxytocin drives labor, and when levels drop, labor slows. That is part of why 50% of women with epidurals require augmentation with Pitocin, which is synthetic oxytocin. Pitocin risks include fetal distress, uterine rupture, cesarean birth, postpartum depression.

Sometimes when a mother has great difficulty relaxing, or is exhausted, an epidural is a blessing. The problem is not the use of epidurals, it’s the overuse. Women with excellent preparation and appropriate support are less likely to find themselves in situations where they need epidurals. Taking an independent childbirth class to learn and practice comfort measures and support techniques, including use of the birth ball, massage, rebozo, hot/cold therapy, counter pressure, ahead of time is invaluable. The more tools the mom has, the better equipped for labor she’ll be. Place of birth matters. Laboring with access to a tub and unlimited food and drink helps. Choosing a professional team that includes a doctor, midwife and/or nurse who regularly support unmedicated women, means laboring with people who know what to do. A doula can also make a big difference; her only job is to provide physical, emotional, and informational support. “Birthing women can never have too much support,” Carol Densmore told me in an interview. “If people seek good support it’s not a sign of weakness or vulnerability. Rather, being well supported and well held, allows childbearing women to access their deepest courage.”

Midwives throughout human history have developed strategies and tools to help laboring women. “The choice is not between anesthesia and unremitting agony.” Sandra Steingraber wrote. “One is not asked to lie in a hospital bed and… bite a bullet and suffer.” Pain in childbirth, unlike most pain, is not a sign that something is wrong. The mom who is in a place mentally where she can understand that and work with, rather than against, her contractions, will experience labor quite differently. And when it is over, when she’s done it, and she’s holding her newborn, she’ll likely have a sense of satisfaction and of her own strength, a great platform from which to begin the work of new motherhood.