If only it were that easy - just tell your OB that you don't want medicine. And yet, for the majority of women that choose to birth without medication, it's an uphill battle.
First, if I'm an OB, I rarely see a birth without medication, mostly because the majority of women want the epidural. It's what I am comfortable with. It's what I learned in medical school and in my residency. It's what I do. When you tell me that you don't want the epidural, I think, "I've heard this one before!" Lots of women tell me that, but few actually follow through. I can have a great influence in how your labor goes. I'll play along though and tell you exactly what you want to hear. A couple of my favorite lines:
"You can hang from the rafters for all I care!" (She's making fun of you with a statement like this. She believes that a civilized woman would never choose to birth without an epidural. She doesn't get it.)
"As long as everything is going smoothly for baby and everyone is safe, I'll let you do whatever you want." (A statement like this reminds a confident woman that birth is dangerous and she might need to be rescued. It's definitely passive-aggressive. You think you're getting what you want, but really, the doctor is putting you exactly where she wants you -- on the verge of thinking you and your baby are not safe. She will come up with a reason to interfere with your labor.)
Unless your care provider is actively helping women have unmedicated births, she doesn't know how to help you. Just because she is catching babies doesn't mean she knows a thing about natural birth.
The noises of a laboring woman make me very uncomfortable, all the moaning. If she's doing it "right" they sound a little too sexy. Eew. You can tell a lot about where she is in her labor, and more importantly, how she is handling her labor. Are the sounds high-pitched and short breathed? She's struggling. Are they low and long deep breaths? She's on top of it. Is she tightening during contractions or letting it all hang out?
Back to my roll-play as the OB, I like it when you have an epidural because ultimately, I'm in control of your labor. I can increase the pitocin and really get this show on the road! I don't want to be at your labor all day/night. With an epidural, you will do whatever I want you to do. If I think breaking your water should be done (I can come up with a million reasons why this is good or necessary for your labor/baby to progress), you'll do exactly what I say.
I also prefer you to stay in the bed on a monitor. When you have an epidural, I like this. You aren't going anywhere - none of this silliness of walking around, bouncing on a birth ball, or moaning like a wild animal in the shower or tub. No, I like you acting civilized in a bed, on a monitor, preferably sleeping.
I also prefer to "deliver" your baby while you are flat on your back with the bright lights on your vagina. Then I can see what I am doing. You can't feel how uncomfortable this is anyway since you have an epidural. This really makes my job much easier. I like a compliant patient. It's easier on my back too. Imagine leaning over a birth tub to catch a baby! Honestly!
In the end, if I decide a c-section is the way to go, you already have an epidural. I can make that call and have things move super fast. If you don't have an epidural placed early on, this delays the c-section. I can always use general anesthesia, but then I really have to justify the emergency factor. The epidural is just so .... easy.
So, please. Just have the epidural and make this easier on us all. Thank you.
Your Typical American OB