The internet has decided that Hannah Neeleman, better known as Ballerina Farm, is a trad wife through-and-through (even if she doesn't necessarily agree with the label herself). 

She dropped out of Julliard to get married and live on a 328-acre farm with her husband and their eight children. She’s a beauty queen, ballerina, mother and loving wife, and just went viral for a controversial profile of her family's lifestyle in The Times of London. 

And while Neeleman has since spoken out against the highly criticized article, there was one detail that went overlooked. 

Inside the descriptions of their daily lives together was a short paragraph on the home births of six of their eight children. Neeleman had seven unmedicated births – and one with an epidural.

“I was two weeks overdue … and (husband) Daniel wasn’t with me … So I got an epidural. And it was an amazing experience,” she told the interviewer. The piece noted her husband was out of the room when she divulged this detail and she shared it in a lowered voice.

Amid a global increase in birth-related fear and anxiety, health providers have seen a shift in the societal pressure to abstain from medicated births.

And while communities advocating for unmedicated births may believe they're empowering women, Dr. Noa Sterling, an OBGYN and health educator in San Diego, says they're "only empowering you if you fit their beliefs and have that type of birth." Experts say it all comes down to misinformation and outdated, toxic beliefs on womanhood and childbirth. 

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Who is ‘Ballerina Farm’ and what are ‘trad wives’?

"Trad wives" are homemakers – women who live “traditional" lifestyles – but have more recently become equated with influencers and an idyllic, Instagram-worthy life. While some look at this aesthetic as idealizing a time where women had fewer rights and independence, many trad wives do not think their roles are degrading; for Neeleman, it’s her choice.

Neeleman was under the spotlight earlier this year for competing in the Mrs. World pageant two weeks after giving birth to her eighth child, and her latest profile in The Times has reignited the "trad wife" versus modern feminism debate. And, it's brought up a much needed conversation on the pressures and stigma associated with medicated births.

What is an epidural? 

An epidural is a small catheter that injects a pain-relieving medication — either an anesthetic or steroid — into the space around your spinal nerves, known as the epidural space. It is usually placed by a certified registered nurse anesthetist (CRNA) or an anesthesiologist, and decreases pain sensations from the belly button down to the toes. 

"A good epidural gets rid of the majority of the pain, but you still feel something. Many people are still able to use a squat bar, move within the bed, and even change positions," says Heather Helton, a certified nurse midwife and social media health educator. A "bad" or dense epidural can leave patients unable to move, which can be challenging during labor.

But Helton emphasizes that in her 21 years of practice, none of her patients have experienced long-term health impacts from an epidural. It's a widely used pain management method in the U.S., with over 70% of birthing individuals opting for it. Contrary to some beliefs, epidurals do not increase the risk of C-sections but can temporarily decrease maternal blood pressure and, in rare cases (approximately 1 percent), cause spinal headaches, according to Helton.

Unmedicated births are often put on a pedestal

There’s a growing number of people who “place unmedicated, low or no intervention birth on the pedestal” and consider medication “a disruption of a natural process," according to Sterling.

Sterling says statements like “your body was built to do this” not only put down women who voluntarily opt for pain medication, but infer that if a person ends up needing a medical intervention, there is something fundamentally wrong with their body.

However, epidurals can play a crucial role in facilitating labor, particularly for individuals who experience significant pain that leads to tension and inhibits cervical dilation. "I've seen people avoid a C-section by getting an epidural," Helton says. When someone is tense from pain, their body can fight the contractions, preventing the cervix from dilating.

“If I see someone visually in pain, tensing up and fighting the contractions, we’ll talk about different types of pain management, including an epidural,” she adds. 

“People have this idea that having an unmedicated birth is better and makes them more powerful and more motherly,” Dr. La Toya Luces-Sampson, an OBGYN and postpartum coach in California, says. “I've actually had a patient tell me, ‘Oh my God, now I’m a woman,’ when she had a vaginal birth after her C-section. It broke my heart. Like, you're always a woman. This does not define you.”

These exclusionary beliefs also ostracize women who cannot or choose not to experience childbirth, whether that be because of infertility, gender identity, sexual orientation or personal preferences. 

What is a 'trad wife'?These controversial women are drawing attention – and opinions

Language matters: ‘Any birth is natural’

Luces-Sampson challenges the terminology around childbirth, calling the term “natural birth” problematic. “That is where the problem starts, right when you start labeling things as natural versus unnatural,” she says. 

She also points out that unmedicated births do not offer significant health benefits beyond avoiding the risks associated with epidurals.

Families, partners and social media can impact how a woman gives birth

Sterling, Helton and Luces-Sampson have all witnessed their patients get pressured by their partners or relatives out of using an epidural. 

With differing opinions on how birth is supposed to go, Luces-Sampson says it is important to be “really careful” about who you let into your birthing space. “Everybody is coming in with their own biases and trauma, and it can really affect that birthing person,” she cautions. 

Sterling had one patient whose husband was against an epidural, and “kept chiming in,” arguing that the “baby wouldn’t come out right” if his partner got one. So, she had to spend time “educating him” during his partner’s labor. 

“When you're in labor and you're trying to listen to your healthcare providers and somebody else is in your ear telling you the opposite, that just puts someone in such a difficult position,” she says. 

Helton has seen partners or doulas talk the patient out of epidurals or attempt to decide on their behalf, and stresses the importance of informed decision-making and autonomy. “This is your birth,” she says. “It's not my birth, your partner's birth, or your nurse's birth."

Studies analyzing the Instagram accounts of midwives found that their posts depicted a greater proportion of vaginal births, water births and home births than known national birth statistics, and therefore are not an accurate representation of the current state of midwifery care and labor. This is particularly influential as 89% of pregnant women turn to social media for advice during pregnancy, and consider their online communities to be part of their "social support network."

The importance of education and autonomy

Educating patients about their options and ensuring they feel in control of their bodies is crucial. Sterling emphasizes the need to respect and address the "very valid distrust" of healthcare providers held by some marginalized communities, particularly Black women.

"We must meet our patients where they are, rather than expecting them to come to us," she explains.  

Helton, Luces-Sampson, and Sterling all believe that epidurals, like any medical tool, should be considered as an option in the context of individual needs, desires and circumstances. 

“It’s not like traditionally women chose not to (have an epidural), it just wasn’t an option,” Sterling says. “An epidural is just a tool. And the ‘natural’ thing for human beings to do is to use tools.”