Pain management is one of them. One forum that I used to frequent often had first-time soon-to-be-moms asking questions like "How will I know I'm in labor?" or "How badly does childbirth hurt?" All perfectly good questions, that are usually met with total crap answers. Of course, the minute the semi-crunchy granola mom like myself answers those questions you're usually scoffed at or blasted for your opinion that pain is different for each woman. "Trust me, honey," one woman says, "you'll want that epidural!"
Well, not necessarily. I am totally not trying to sound like SuperMom in need of a "vag badge" (good Lord, I hate that expression!), but geez, pain management is different for everyone! I usually tell people, when they ask, that you should take it as it comes - not insist for an epi the minute you step off the elevator - but wait and see what happens. You might get through it and say, "That wasn't too bad," or maybe need something like Nubain instead. There are alternatives to an epi that can bring some relief, or at least relax you so you can focus on the business at hand.
I had Nubain with my vaginal birth and while it didn't do squat for the pain, it at least made me not care about it. LOL I remember getting half way through my delivery thinking, "Maybe I should get an epidural." Then I thought, "Nope, too late for that." (Maybe it was the Nubain talking? Who knows. LOL)
With my third child, I essentially went through the entire labor, minus the pushing stage, and didn't have anything. It wasn't anything terribly unmanageable until my water broke, and even then, changing positions totally helped. That's the thing - pain is different for everyone, and can be totally dependent on a number of things: your positioning, the baby's positioning (back labor stinks!), and especially your state of mind. If you go into it with another woman's idea of what pain is, simply because they told you "you'll want that epi!," then you're bound to be scared to death and clenched up tighter than a clamshell about to relinquish its prized pearl.
Midwife Ina May Gaskin has a terrific analogy for this, which she calls "Sphincter Law," as far as relaxation and dilatation during labor. Picture a man who's been offered a $100 bill, if only he can pee in front of 50 people. There's no way that's happening, right? Just like some people can't go to the bathroom in strange places, giving birth can kind of be the same way for some people. If you're more focused on the pain, or especially the idea that strange people are in the room looking at your female parts, then you cannot relax and neither can you effectively dilate. Some women no doubt become exhausted at this point and stall, causing the cervix to stop opening.
One thing I did to encourage dilatation was to meditate and picture in my mind the cervix opening up, almost like a flower. I pictured the chart in my doctor's office that shows the different stages of dilatation, and made a circular shape with my hands to further illustrate that point to myself. For my third baby, I actually carried the lid of a coffee can (which is roughly the same size as a fully dilated cervix - can you believe it?) around in my purse LOL and looked at it whenever I thought about it. (Perhaps it worked a little too well, then, when I showed up at the hospital and my water broke as I was signing myself in!)
Other ways to manage pain in labor can include massage, walking and changing positions. With my second baby, she was nearly posterior, which meant painful back labor. Lying on my left side encouraged her to turn, which made the pain much more manageable. Having a doula present can also help by keeping you focused on something other than the pain, and has been shown to decrease the rate of epidural use. Either way, if you decide to have one, then that's perfectly okay - some women have other issues going on that might necessitate having one, and there's nothing wrong with that.
Whatever happens, I encourage women to take it on a "let's wait and see" basis, because you just never know how things will turn out. If you go into it having low expectations, then they will almost always be met. But if you think positively and say to yourself, "I think I can do this!," you might be pleasantly surprised.