The women in Lynsey Dietze's family have big babies. They also have Caesarean sections. Her mother, her sister, her two aunts -- they all had major abdominal surgery when it was time for their babies to enter the world. And after watching her sister suffer through a difficult labor that ended in a C-section, Dietze vowed to do things differently when it was her turn.

Dietze got her chance to have things her way 20 months ago, when she gave birth to her first child. Before her baby girl arrived, the Oceanside woman immersed herself in research material on childbirth. Everything she read supported her hunch -- giving birth naturally was the right choice for her.

She enrolled in Bradley Method childbirth classes taught by Liza Janda, who is based in North County.

Dietze learned relaxation techniques, what to expect of labor and how to physically train for birth. After 12 weeks of classes, her plan to attempt a natural childbirth was cemented.

Why go natural?

Nowadays, the number of women who seek a drug-free birth are few, but their reasons are plenty.

For Megan Rosenstock, it was an innate desire to do what women have done since humans lived in caves.

"We were created to have babies as women. And I wanted to experience it. I wanted to have my child without him having any drugs in his system," she said.

For Sabrina Lambertson, who had a baby naturally Aug. 26 after first unsuccessfully attempting it four years ago with her son and again two years later with her daughter, it was more a journey of self-realization. Lambertson received an epidural for her first two births and both times her labor slowed and a C-section seemed imminent. After ending up with a C-section during her first child's birth and very nearly having one the second time around, Lambertson was certain her body and pain-relief drugs didn't mix.

"I'm by no means an expert, but I've learned so much about birth since the beginning Lamaze class (we took for our first birth)," Lambertson said. "I hope people will learn to get more information and knowledge, because they don't teach enough about rights and choices. One thing I've learned is once you get one intervention (like an epidural) it leads to one and then to another."

Many natural-childbirth advocates feel that interventions such as Pitocin (given to speed along labor) and epidural (used to numb the pain) get in the way of the natural process.

An epidural is administered by inserting a catheter into the lower spinal area, which allows for a continuous flow of numbing drugs to the lower body.

According to Childbirth.org, a Web site advocating natural childbirth, getting an epidural restricts mobility and forces a woman to have an IV. Side effects can include nausea, vomiting, shivering, prolonged labor, uneven pain relief, respiratory insufficiency and headache, the site states. And many women who choose natural childbirth do so out of concern for their babies. Some say they don't think it's a good idea to introduce drugs into their bodies when they've been told throughout pregnancy to avoid seemingly benign over-the-counter medications and caffeine.

Natural-childbirth advocates believe that women are designed to give birth and that trusting in that knowledge is key. Advocates stress the importance of walking, squatting, kneeling, getting on your hands and knees, dancing and relaxing in a shower or tub to get labor moving along and the baby out. But once an epidural is administered, the bed is where most must stay. (A walking epidural does exist, but it's not widely available). Natural-childbirth advocates say lying in bed does not help labor progress.

"There is a power in all of us," said Bradley instructor Janda. "It's there, but your fear gets in the way. … If you leave a woman alone (no interventions) but support her, she's going to blow her own mind. I'm the biggest wimp in the world and I had two natural births."

The fear factor

Doctors, nurses and childbirth experts point to fear as one of the biggest hurdles women must leap when approaching childbirth. The fears are many: Is it going to hurt? Will the baby be OK? Am I up to the task of parenting? Etc., etc.

"When a woman is under a great deal of stress, she releases adrenaline," said Dr. David Priver, a San Diego OB/GYN who has been delivering babies for nearly 35 years. "It diverts blood away from the internal organs. You need an intense blood supply to the uterus to allow it to contract. … The stress issue is a terribly important one."

Childbirth classes such as Bradley, Hypnobirthing, Hypnobabies, Birthing From Within and Lamaze all teach relaxation techniques to combat the fear surrounding birth.

"We (practice) relaxation every single time because that is the key to pain management during labor," said Sheri Simmons, a perinatal education instructor trained in Lamaze at Palomar Pomerado's Women's Health Connection. "The more relaxed a woman is, the less pain she'll experience."

Carlsbad's Sheri Menelli -- a former Hypnobirthing teacher, author of "Journey Into Motherhood" and founder of the Birthing Business Institute -- can attest to this theory. As the mother of a 5-year-old and 20-month-old twins, Menelli knows firsthand how fear can lead to more pain.

"My daughter was a little early," said Menelli. "(The hospital staff) scared me for about an hour. I actually was feeling pain. I was under intense fear that she would have to stay in the hospital. About an hour later, I thought, 'I could have a really horrible birth and then there goes my Hypnobirthing career.' … I decided that I was the only one who could control what was happening in my body and I was going to have a good time at my birth. I just ended up having a fantastic experience. The pain just went away instantly for me."

Epidural: The popular pain reliever

While Menelli used self-hypnosis methods to achieve a pain-free birth, most women turn to the epidural for pain relief.

According to the August issue of Parents magazine, "Pain-free is back in vogue." The American Society of Anesthesiologists would concur. In larger hospitals, the society found that in 2001, only 6 to 10 percent of mothers had no pain relief, compared with 11 to 33 percent in 1992. Statistics vary by hospital, but if you go back a little further, the 1998 issue of American Family Physician reported that only 22 percent of women in 1981 received an epidural.

Locally, Dr. Thomas Moore, professor and chairman of the Department of Reproductive Medicine at the UC San Diego School of Medicine, reports that UCSD has an 80 percent epidural rate but that many area hospitals hover around 90 percent today.

The hike is partially due to the increased availability of anesthesiologists. Women have also become more familiar with the epidural. And Priver and Moore agree that epidurals have improved over time. Most insurance companies cover epidural procedures as part of their standard birthing policy.

"The scientific data do not show a significant difference in mother and baby outcomes between women receiving labor analgesia (pain relief) and those without," Moore said. "On the personal or subjective side, I have talked to many women who were extremely positive about their birth without pain relievers, but also an equal number who were miserable and angry when they could not receive their epidural 'on time.' "

"I just think that the epidural has been refined so much," said Priver. "Epidurals were once so dense that (women) could barely move. Nowadays, they have been so refined that (women) still have muscle control. It doesn't interfere (with the pushing). Recent studies show that the epidural does not have any adverse effect on labor."

Why the high epidural rate

Some natural-childbirth advocates and health care professionals cite television as a reason for the high rate of epidurals. Others say that women have lost faith in their own birthing abilities.

According to Janda, "Doctors are giving women the message that our bodies are broken and we need drugs and technology in order to get that baby out. As a result, women are scared, aren't trusting their bodies or themselves and their instincts (to give birth naturally)."

Moore sees the high rate of epidurals as a result of our culture and what is being shown on television about birthing.

"In most cultures, girls observe and become comfortable with birthing," said Moore. "We are not helping young women know about birthing other than Discovery Health (TV channel), which portrays crises and Caesareans. So young women are afraid of vaginal birth. It is a shame."

Childbirth educator Menelli says epidurals have become so commonplace that women don't consider other options. Like Moore, she blames television for depicting horrific birth experiences that scare women into expecting trauma and drama.

"I think that part of (the high epidural rate) is the media," said Menelli. "You see epidurals constantly mentioned. I think it's a cultural thing because whenever anyone is pregnant, they say, 'just get the epidural.' When you go to hospital classes, they're teaching about epidurals. I really believe it increases the epidural rate. I think that, unfortunately, as a society we're not educated that there are much better ways of getting pain relief than an epidural."

Flexibility is key

While Janda and Menelli obviously advocate natural childbirth, both agree that epidurals have their place, as do C-sections. Both teach their students to be flexible when approaching birth.

Janda says a former student of hers was in labor for 2 1/2 days and was intent on giving birth naturally.

"This woman stayed at home for 60 hours in labor," said Janda. "Her doula (childbirth coach) was able to listen to the heart rate, so they weren't being careless. She called me up and I said, 'It's not a sin to get an epidural.' "

A healthy child and a healthy mom are more important to natural-childbirth advocates than a drug-free birth experience. They stress this over and over in classes they teach.

"I honestly think if mom's healthy, baby's healthy, it doesn't matter how it comes out," said Janda. "I don't want anyone taking my class and feeling they're a failure as a woman. It breaks my heart if someone feels guilty or thinks they didn't do what they're supposed to do. Even though I'm an advocate of natural childbirth, and most people can do it if they're surrounded by support, I want to give them all the information so they can have the best delivery for their family."

Three experiences

Dietze, Rosenstock and Lambertson all said that the childbirth classes left them well-prepared.

For Rosenstock, however, a natural childbirth was not to be. While she is thrilled to have baby Quinn, she was disappointed that after 19 hours of labor she was unable to push the baby out and that she required a C-section. Rosenstock made it through all 19 hours without an epidural by using the Bradley Method. And she would like to try again next time. "I will probably keep working on my relaxation techniques," she said.

Lambertson is thrilled to have finally had the birth she desired. After two attempts, the third try resulted in a successful natural birth. She said the recovery time after the natural birth was fast.

Lambertson, an advocate of VBACs (vaginal birth after Caesarean), is angered when doctors advise women to have second C-sections.

"The recovery after the C-section was very hard," she said. "Some bounce back, but it's difficult. You don't get to bond with your baby as much as you do after a vaginal birth. You go through a lot of psychological stuff, too. In a way, it gave me the surge to know that I wanted to do it differently next time around. … I wanted to feel that strength from within."

And then there's Dietze, who hit the ball out of the park on the first try. Determined to change her family history of C-sections, Dietze took Bradley classes and prenatal yoga to prepare for her daughter's birth.

Forgoing the epidural, Dietze breathed through the pain and delivered her 9-pound, 3-ounce daughter at the UCSD Birthing Center. She's pregnant again, and after the positive first experience, a second natural childbirth is planned.

"I never really knew how amazing I'd feel after having my baby," Dietze said. "I seriously thought I could run laps around the hospital. I felt great to overcome that everyone in my family had had a C-section.

"From the moment I had her, I never questioned my abilities," she continued. "When it came to changing her diaper, giving her a bath, I didn't question my abilities. I definitely see my confidence as a mother completely stems from my birth experience."

- Staff writer Pamela Reeder can be reached at (760) 739-6671.

Natural childbirth opttions:

If a natural childbirth is what you want, you can achieve this goal at any hospital, at home or at a birth center. However, natural-childbirth advocates throughout San Diego County favor three places in particular:

• Scripps Memorial Hospital, Encinitas (www.scrippshealth.org/Locations.asp?ID=391), 354 Santa Fe Drive, Encinitas, (760) 633-6501.

According to Scripps' Web site, "Women can choose to have a traditional physician-attended delivery or delivery by a certified nurse-midwife, who works closely with a physician." Scripps is a full-service hospital and epidurals are readily available.

• UCSD Birthing Center (health.ucsd.edu/Women/child/facilities/center.htm), 200 West Arbor Drive, San Diego, (619) 543-3863.

The UCSD Birthing Center boasts "family-centered maternity care in a comfortable, homelike setting, including five spacious birthing suites, a family room with kitchenette, a play area for siblings and a parent resource library." The Birthing Center does not administer epidurals and encourages women to walk during labor and use a birthing stool, a birthing ball, hydrotherapy and more. The Birth Center only accepts low-risk pregnancies.

The site stresses that, should the need arise, more intensive medical care is available at UCSD Medical Center's Labor and Delivery Unit, just minutes away.

• Best Start Birth Center (www.beststartbirthcenter.com), 3343 Fourth Ave., San Diego, (619) 299-0840.

Care at Best Start Birth Center is provided by nurse-midwives. It is the only facility in San Diego that offers water births. The birthing rooms offer a homelike feel.

Best Start does not offer epidurals. Only those with low-risk pregnancies can deliver at Best Start. The midwives at Best Start have privileges with UCSD Medical Center, so, if necessary, a transfer is possible.

Birthing methods

Most who take childbirth classes at a hospital learn some form of Lamaze (www.lamaze.org) training, which has been around since the 1960s, but that isn't the only training method to prepare for childbirth. Here are a few others:

• The Bradley Method (www.bradleybirth.com):

The Bradley Method teaches natural childbirth. According to its Web site, The Bradley Method "encourages mothers to trust their bodies using natural breathing, relaxation, nutrition, exercise and education." Bradley classes last 12 weeks, meeting once a week.

The Web site states that nearly 90 percent of Bradley students who have vaginal births do so without pain medication.

There are many Bradley instructors in North County and Southwest Riverside County. Visit the Web site for more information.

• Hypnobirthing (www.hypnobirthing.com):

Hypnobirthing also teaches natural childbirth. According to its Web site, "the method teaches you that in the absence of fear and tension, severe pain does not have to be an accompaniment of labor." Some women who have used the Hypnobirthing technique say labor was painless. The method teaches relaxation and stresses a calm birthing environment.

The site states that "you and your partner will learn to use self-hypnosis, guided imagery and special breathing techniques that can help to bring about a shorter, easier, and more joyful birthing, free of harmful drugs for you and your baby." Hypnobirthing classes are 2 1/2 hours and meet once a week for five weeks.

Hypnobirthing practitioners are available in North County and Southwest Riverside County and can be found on the Hypnobirthing Web site.

• Hypnobabies (www.hypnobabies.com):

Hypnobabies bills itself as "No drugs for baby. No pain for mommy." It teaches hypnosis techniques to foster relaxation.

According to its Web site, mothers who practice Hypnobabies techniques "have their babies in a state of deep relaxation, with little or no discomfort or fear." Hypnobabies is a five-week course. Its Web site states that 70 percent of women who use Hypnobabies techniques have pain-free birth experiences.

Hypnobabies does not offer classes in North San Diego County or Southwest Riverside County. However, classes can be found in Mission Viejo, Coronado, La Jolla or Irvine. Check out the Web site for class information.

• Birthing From Within (www.birthingfromwithin.com):

According to the Birthing From Within Web site, teachers of this method "believe that childbirth is a profound rite of passage, not a medical event." Birthing From Within tailors its classes to the needs of the students. Birthing From Within is similar to Bradley in that practitioners teach that pain is "an inevitable part of childbirth, yet much can be done to ease suffering." According to the site, expectant parents learn mind-focusing practices, self-hypnosis and visualizations.

Classes generally last for six weeks. Birthing From Within offers classes in San Diego, but there aren't any currently offered in North County or Southwest Riverside County. To obtain class information, visit the Birthing From Within Web site.