In-Hospital vs. Out-of-Hospital
If you're planning a hospital birth, there are many things there that will undermine your attempt to birth naturally. For example:
Natural birth is more painful in a hospital than outside a hospital. In a hospital your laboring position(s) will be limited by fetal monitors, IVs, hospital staff requests, and simple lack of facility to support a variety of positions (for example, if they don't have a birth stool, you can't labor on one). There is no continuous professional labor support staff to help you find and to implement the natural methods that are most effective in controlling labor pain for you, even if they are available. For example, there is no staff available to put counter pressure on your back during each contraction, a most effective method for reducing labor pain. This lack of support and options will make your labor more painful, and make you more likely to need an epidural. In a birthing center or at home you have many more effective options and you have continuous, professional labor support and people dedicated to helping you through your labor.
You are more likely to accept drugs in a hospital because they are so readily available. They will certainly be offered to you, perhaps many times during your labor. At an intense moment in your labor you may yield to these offers, whereas if you were properly supported in a birthing center or at home you wouldn't feel the need for them or be exposed to this suggestive undermining of your natural birth desires.
It's more convenient for the hospital and doctors for you to have an epidural, and they will encourage you to do so. An epidural makes you less likely to make requests of the staff, and makes it easier for the staff to call your doctor to arrive "just in time" to catch the baby. Without an epidural you will want more frequent visits from the nurses, have more questions, require more support, and they will have to call the doctor sooner for your delivery because without an epidrual the exact timing of the delivery is less predictable. Without an epidural they can't reasonably tell you not to push if the doctor hasn't arrived yet because, if undrugged, your uterus will do it's job on it's own time. This convenience factor makes it more likely the hospital staff will encourage you to have an epidural.
Hospitals and the providers who work there get paid more when you have an epidural. This gives them a profit motive to encourage you to have one. Did you know that when you have an epidural you have to pay an anesthesiologist you otherwise would not have to pay, your nursing charges per hour increase, the amount of supplies and drugs you will need will increase, and your complications rate will increase, likely resulting in further procedures and charges? The estimated total increase in cost when you have an epidural (including hidden charges no one tells you about) is about $2,000. Even if you have insurance and do not have to pay these charges yourself, it is important to realize that the hospital and its staff do have financial pressure to encourage epidurals.
You are less able to handle labor in a hospital than you are out of hospital. When you step into a hospital in labor you will be in a strange place, lying in a strange bed, cared for by strangers to you. You will be asked to strip and don strange clothes, you will be hooked up to a variety of strange wires and tubes, and suddenly there will be strange rules for what you can and cannot do, which you will have to discover as you go along. The combination of all this strangeness results in a personal sense of insecurity that most people don't realize until they leave the hospital. Have you ever asked permission to go to the bathroom, drink a glass of water, or have or hold your baby? I guarantee you'll do it in the hospital. This insecurity will undermine your confidence in yourself and your body to birth naturally, and will increase your fear, which will increase your pain, and it will make it more likely you'll choose an epidural.
I just wanted to say thank you for making it possible for us to have a home birth. In spite of the pain, it was such an awesome experience to have Joaquin here at home, that I wouldn’t trade it for 1000 epidurals. I really admire what you do, the patience you have, and your knowledge. This experience has really changed our lives.-Yamile Mendez
Statistically, you are 10 times more likely to have a c-section when you plan to birth in a hospital as when you plan to birth in a birthing center or at home. 90% of the c-sections resulting from these hospital-planned births are unnecessary. About 20% of hospital-birthing women in Utah have a cesarean, but only about 2% of women who plan a birth center or home birth have a cesarean, with similar outcomes in all locations. Which odds would you prefer?
Many of these things are not engineered to disrupt your natural birth plan, but they do disrupt it nonetheless. If you want a natural birth, your best bet is to have your baby in a birthing center or at home with a skilled midwife.