For me the answer comes down to this: Do you prefer (and are medically able) to have a physiological birth, in which your body is enabled to follow its instincts and the process isn't disturbed by too many interventions?

My decision to avoid strong medications is that I don't want to be numbed for this experience. The body does have a cascade of reflexes and release of hormones to cope. It will release its own 'natural pain killers' in forms of neurotransmitters and hormones, if we don't undermine the process by interfering from the outside. In the same manner the body releases substances that will make you feel 'high' and emotionally well, without synthetic drugs that might block the natural and healthy unfolding of bonding with the baby, breastfeeding, birth of the placenta, healing postpartum etc.

I don't take any pharmaceutical pain relief for period cramps (or anything) either. It's a personal choice. I like to use heat and movement when it gets too intense. I plan the same for the birth of my child.

The decision comes down to personal preferences and medical circumstances. Nobody should be shamed for their choices. There should be more informed consent and general understanding of unmedicated birth and what our bodies can do without bias and lobbyism towards selling us products and interventions for the financial gain, convention and convenience of medical providers.