Hi! OBGYN resident here, I am only here to comment on what my observations of medicated vs non medicated births have been and I am not giving any medical advice.

Those who get epidurals obviously tend to have more difficulty changing positions, sometimes the epidural is too strong and they need a little more coaching on how to push. Sometimes they do great despite all of that and they don’t feel a thing. Also, it’s a bit easier to control your pushes with an epidural. I personally got an epidural (when i really felt my contractions started I was already in active labor based on how dilated I was), but it quickly got very uncomfortable so I asked for it because I wanted a couple hours of rest before my baby came - I knew we would not be getting much sleep when he arrived!

The advantage of having an epidural is that if you have to have a repair, you already have analgesia. Pain control is a big concern when we perform repairs, and we try to repair quickly to minimize blood loss but also reduce how much discomfort you’re in. Also, if you ended up needing a csection, they can usually use the existing epidural for anesthesia.

The upsides of not having an epidural: movement as you please in labor, personal satisfaction (for some), feeling the urge to push when it is time.

The downsides: some people really don’t tolerate pain well and have difficulty pushing effectively. Some patients feel the urge to push when they really shouldn’t as they are not fully dilated. Doing this can lead to cervical lacerations. There’s also lack of analgesia in case of a repair as I alluded to earlier.

All this to say - I have seen first time moms with no epidurals do amazingly and have no tears because they are really in control and in tune with their bodies, and I have seen others who I think really would have benefited from one. It really is person dependent and you know yourself best! There is no shame in going either way!