SINGAPORE – When it comes to childbirth, many women opt for pain relief, with epidural being a common choice.
However, some are choosing to forgo this medical intervention, trusting their bodies and drawing strength from personal beliefs.
For 32-year-old primary school teacher Hannah Loke, her initial feelings about childbirth were much like many other women’s – fear.
“I was super scared of giving birth,” she says, adding that media depictions of women in labour, often shown in distress and pain, had influenced her perspective.
But a book gifted by her sister-in-law, who underwent three home births, changed her perceptions.
Written by American midwife Ina May Gaskin, Ina May’s Guide To Childbirth detailed how the vast majority of women can give birth naturally, using non-medical techniques for managing pain.
“After educating myself, I realised it was possible to give birth without medication,” says Ms Loke.
Her decision to avoid an epidural was rooted in her Christian faith and made early on in her pregnancy. Twenty weeks into it, she had attended a birthing class, and was preparing herself mentally and physically for a drug-free birth.
“The class taught me breathing techniques and the importance of movement,” she says.
Sound breathing, in particular, became a key tool for managing the pain of contractions.
“You take a deep breath in and when you breathe out, you make a low sound. High-pitched sounds tense up the muscles, but low sounds help you relax,” she says.
On the day of her labour in April, Ms Loke recalls the progression of contractions, comparing early contractions to mild period cramps that intensified as labour progressed.
“What the birth class did was equip me with a bag of tricks to manage the contractions,” she says.
These “tricks” – which involved breathing techniques, movement, and the use of warm water – helped her stay calm and focused throughout the process at home.
“I arrived at the hospital when I was 10cm dilated, and there was no time for anything else: no epidural, no laughing gas, just pushing,” she adds.
She gave birth to her first child, Abigail Seah, in April at Thomson Medical Centre, 45 minutes after reaching the hospital.
Ms Loke’s story is part of a broader movement of women choosing to forgo pain management medication, driven by the desire for a more natural birth experience and a belief in the body’s ability to handle labour.
Ms Hannah Loke and Mr Ezekiel Seah with their baby girl, Abigail Seah, at Thomson Medical Centre, in April. PHOTO: DEANNA KEARNS
Why some skip the epidural
While the epidural is regarded as the gold standard for pain relief during childbirth, there are several reasons women choose not to take it.
Dr Oh Ting Ting, a visiting obstetrics and gynaecology anaesthetist at Thomson Medical Centre, says a large proportion of women have personal or cultural preferences, in which they prefer to experience natural childbirth in its entirety, including labour pains.
At Thomson Medical Centre, about 45 per cent of mothers opt for an epidural every year.
At KK Women’s and Children’s Hospital (KKH), the largest maternity hospital in Singapore, the number of epidurals administered has remained stable at over 5,000 a year.
Professor Sng Ban Leong, the head and senior consultant of KKH’s department of women’s anaesthesia, says it is the most preferred choice of pain relief during labour for vaginal deliveries at the hospital.
It is uncommon for women to choose a vaginal delivery without any form of pain relief, he adds.
At Singapore General Hospital’s (SGH) labour ward, the epidural take-up rate from January to July 2024 ranges from 56 to 65 per cent, which is quite consistent with previous years.
A very small number of women opt for drug-free births, says Dr He Yingke, consultant and director of obstetric anaesthesia at SGH’s department of anaesthesiology.
Ms Chantel Kismet, a certified birth doula with six years of experience in supporting over 200 mothers, says there is a growing awareness for exploring drug-free births among her clients.
A birth doula is a trained professional who provides physical, emotional and informational support to a woman before, during and after childbirth.
About 75 per cent of Ms Kismet’s clients want a drug-free birth, but 8 to 10 per cent of that group end up taking some pain relief medication during labour.
Certified birth doula Chantel Kismet gently massaging a woman’s lower back for comfort and relief during labour. PHOTO: UNISONPHOTO
“Some women choose to forgo the epidural because it numbs the lower half of the body. They prefer to maintain a certain level of control during childbirth and actively feel the process,” says Ms Kismet.
Some have a fear of needles and would rather not take the epidural, she adds.
There are also those who have medical contraindications, like a blood clotting disorder, which does not allow the use of an epidural as it puts them at risk of excessive bleeding, says Dr Oh.
Enduring labour without pain relief
Certified birth doula Warda Yusoff, who has assisted more than 500 mothers with childbirths over 15 years, says giving birth without pain management medication requires immense effort, patience and perseverance.
About 70 per cent of her clients aim for a drug-free birth, but only 30 per cent achieve it.
Most of the women who succeed in doing so are second- or third-time mothers, whose previous experience makes them better prepared for a natural birth.
Certified birth doula Warda Yusoff speaking to a couple about birth preparation. PHOTO: AZFIAN ANUAR PHOTOGRAPHY
A significant factor contributing to women changing their minds during labour is the intensity and duration of pain, says Ms Warda.
First-time mothers, in particular, may not be fully prepared for how long the labour process can last, often stretching between 18 and 24 hours.
“The sleepless hours of enduring pain can lead many to opt for an epidural midway through labour, despite their initial plans,” she says.
For some women, the desire to give birth naturally is driven by cultural or familial expectations.
“Their mother, grandmother, sister and friends did it without pain medication, so they feel they can do it too,” says Ms Warda.
But this mindset is not always helpful. “Every woman’s birth experience is unique, and the decision to go without an epidural should be based on individual circumstances, not comparisons with others,” she advises.
Peer pressure also plays a role.
“In the modern world, where pain relief medication is readily available and if you don’t use any, you’re seen as super strong,” says Ms Warda.
For these women, natural childbirth becomes a badge of honour, a symbol of endurance and confidence, she adds.
Ms Warda observes that women who opt for natural childbirth often share certain personality traits.
“These women tend to be CEOs, entrepreneurs or in leadership roles,” she says.
Finance manager Andrea Seet, 32, decided to have an epidural-free birth after conducting her own research and speaking with other mothers.
“I wanted to avoid experiencing possible long-term side effects from taking an epidural, as a mummy friend was sharing with me her experience of lower back pains. I was also curious to witness first-hand how the female anatomy is uniquely designed to withstand labour pain,” she says.
To prepare herself for birth, she drank raspberry leaf tea throughout her pregnancy, as it is believed to tone the walls of the uterus and help ease the labour process.
“Besides that, having a positive mindset and a supportive husband helps too,” says Madam Seet. She is married to Mr Qaiser Tia, a 33-year-old associate director in the finance industry.
She tried pain relief gas, also known as laughing gas, in the early stages of labour, but it had no effect on her.
To manage the pain, she concentrated on breathing techniques, and relied on her husband to press pressure points on her back whenever she experienced a contraction.
“During the active labour stage, I could feel every contraction fully and never anticipated this level of pain. By going through labour without an epidural, I felt more connected to my body’s natural rhythms, and knew when to push without needing direction from the nurses and doctor,” she says.
“While the pain was significant, it was a profound part of the experience, making the moment of birth feel even more rewarding. It also highlighted my body’s strength and resilience,” adds Madam Seet.
She gave birth to her first child, Kayla Tia, at Mount Elizabeth Novena Hospital in September 2023.
Madam Andrea Seet with her one-year-old daughter, Kayla Tia. ST PHOTO: ONG WEE JIN
Lasting effects of unmedicated births
For those who push through the pain, the experience can leave a lasting impression.
Ms Warda has encountered women who endured 30-hour labours without pain relief, only to be left traumatised by the experience. Some experience significant post-partum challenges, such as depression, difficulty bonding with their baby or even sexual reluctance.
“They are still processing and remembering the massive pain they felt,” she says.
For these women, natural childbirth becomes a psychological hurdle they need to overcome before considering having another child.
While some women believe it is important to experience labour pain so the experience of being a mother is “complete”, severe pain may cause a rise in the hormone catecholamine, which will increase blood pressure, heart rate and trigger the release of stress hormones, highlights Dr He.
The result could be more severe in patients who already have high blood pressure or ischaemic heart disease.
On the other hand, women who use pain relief medication often report a vastly different experience.
Some who receive an epidural in active labour do not even realise they have pushed a baby out due to the numbing effect, says Ms Warda.
Debunking misconceptions
Some women choose not to get an epidural due to the misconception that it leads to back pain in the long term. But studies have not shown an association between epidurals and long-term back pain, says Dr Oh.
“With or without an epidural, back pain is common after childbirth. The more likely culprit is the constant bending and lifting required for newborn care,” she says.
Dr He says back pain is common during and after pregnancy due to hormonal changes causing the relaxation of ligaments, as well as stress on the back from the uterus carrying a developing foetus, especially during the late second trimester or third trimester.
There are also women who worry that an epidural may harm the baby. But the medication stays in the epidural space around the spine, with no or very little systematic redistribution. This means that the medication will not cross the placenta and affect the baby, explains Dr He.
Alternative pain relief options
“First-time mothers who wish to test their pain threshold may initially attempt non-drug methods, progressing to pain relief gas, injections or epidural pain relief if they require it,” says KKH’s Prof Sng.
The side effects of the epidural on a woman are predictable and usually transient, he says. They include shivering, itch, nausea, fever, muscle weakness and headache.
As with any needle injection, Dr Oh says there is a risk of bleeding and infection at the injection site. Nerve injury is extremely rare, she adds.
For Ms Loke, the transcutaneous electrical nerve stimulation machine was very helpful in relieving pain during labour. ST PHOTO: CHONG JUN LIANG
Non-medicated methods like hypnosis, acupuncture, heat or cold application on the abdomen, lower abdomen or lower back, and transcutaneous electrical nerve stimulation (tens) can also help manage pain during labour, says Dr Oh.
Ms Loke, in particular, found the tens machine very useful, adding that “it was my last line of defence” against the pain. The device, which she borrowed from her doula, uses mild electrical impulses to relieve pain by stimulating nerves and reducing the perception of discomfort.
Partners left in awe
Regardless of the reasons behind the choice to forgo or use pain relief during childbirth, Ms Warda observes that partners often gain a newfound appreciation for their wives’ strength after witnessing a natural birth.
“They see how tedious and intense it is,” she says, which fosters admiration and respect for what their partner has endured.
Ms Loke’s husband, Mr Ezekiel Seah, was nearly moved to tears.
“I felt helpless because I couldn’t do much but support and cheer her on, and at the same time marvel at the sheer strength and grit that she possessed to go through this,” says the 39-year-old, who works at a halfway house.
Mr Tia says his wife is a champion for giving birth without an epidural by choice. ST PHOTO: ONG WEE JIN
Madam Seet’s husband, Mr Tia, says it was heartrending to see his wife in pain. He calls her “a legend” for giving birth without an epidural by choice.
“She delivered my daughter like a true champion. My appreciation and love for her have deepened tremendously. I called her a champion for weeks after and am super proud of her till this day,” he says.
