That is the question...
I had two back to back calls the other day, regarding epidurals. The first was a "potential client" who called to say she wasn't going to need my services after all, because she'd just had her baby that morning (in very short order). She was surprised how quick and simple birth was - surprising since, as a family doctor, she'd been attending births for some time, and had anticipated something more hellish than she encountered. She said she now understands that the decision to have an epidural isn't one that can be made before birth. It's all about responding to the needs of the day.
The other call was from a woman interested in hiring me as a doula. She had read my "Statistics for the Utterly Confused" and just wondered if I had an agenda to eliminate epidurals (since my client epidural rate is significantly lower than the general population). Um...nope. My clients who labour without epidurals aren't self-flagellating ascetics or martyrs (as TV may have you believe). They are women who, with the help of a doula and caregiver who trust in birth, happen to have straight-forward normal births, and then say, "Hey! I didn't even think about meds."
A smooth and simple birth requires you to be present, conscious, and conscientious on the day of labour. In that mindset, you will make the right choices, and use the necessary tools for the day, simple or otherwise. Most days, all that's required to help a woman give birth are love, eyes, ears, hands and wisdom. But, if the day throws some major curveball at you, then a few more tools (including an epidural and more than a pinch of pragmatism) might be required.