Well, I'll give you my best tips! My first was a pitocin induced labor w/ AROM and then an epidural b/c I was unable to breathe b/c of the contractions being suddenly so hard. My second birth was completely natural, no pain meds. Both were hospital births, too. With my first I do not feel I was prepared at all for what labor would feel like, I had a hard time breathing b/c the pit. made the cx never stop, they just peaked, then peaked again without me getting a break. I too was afraid of making too much noise, and I didn't know enough to just say "No" to the nursing staff, or to tell them I wanted out of the bed. Don't make any of those mistakes! With number 2 here is what I did.
1. Relaxation breathing, start practicing now, kinda like a relaxing deep breath in, then exhale. Focus on the in and out of your breath and opening your body. Do this for every contraction for as long as you can (I did it until transition). Don't loose control of yourself and release all of your fears. Those things cause our bodies to tense instead of relax. You are wanting your body to open up and welcome your baby. For every cx. I would chant "Open Body. Welcome Baby" either silently or out loud. By focusing on my breathing and relaxing of my muscles, I didn't even have the need to scream.
2. MOVE! Roll on the birth ball, walk the halls, rock on all 4s, whatever works for you (I did all those at some point). Do not lay flat on your back. It hurts, the cx. hurt much worse. Infact, when my nurse needed to do the monitoring I just stayed on the birth ball instead of laying in the bed. I just told her that laying down made them 10x worse, and I wasn't getting into the bed. I'd gladly stand next to the bed or get on the birth ball, though. I wasn't rude or difficult, just matter of fact. My nurse had no problems with this at all and repeatedly told me I was doing great.
3. Ask for help when you need it, tell your partner what you need him to do, or ask a nurse if the two of you need help. Call ahead of time and know what types of equipment is available for you to use (birth ball, squat bar, ect.) Also let your nurse know in the beginning you are wanting a natural birth. Make sure she is supportive of you and willing to help you! Sometimes if you let the staff know they will assign you a nurse that's more into the natural birth thing. I know my nurse really helped w/ the birth of my second DD. You could tell she just really liked attending a natural birth and she was very supportive (on a side note she also taught our birth class and had 5 kids herself, all different ways, so she was a great help). I SO wish my first birth I had asked for a different nurse. Mine didn't really know anything besides "rate your pain on a scale of 1 to 10" and "Let me know when you need the epidural" No other pain support or advice at all. Sad, really. I didn't know any better
Who knows how different that would have gone if I'd had a different nurse?
4. Take one cx at a time. Just get thru the one you are on and don't think about the rest. Rest between and don't think about the next one!
5. THe worst part is the crowning. It does hurt, no getting around that, but it only lasts for a few seconds. You can do ANYTHING for just a few seconds. That was teh ONLY time durring my labor that I got really vocal. I started hollering "Get it out! Get it OUT!" and I did loose my focus for a few seconds. Luckily my OB and nurse called me back, and I was able to slowly push her out w/o any tearing!
Good Luck! And know that even if you DO end up w/ another epidural that doesnt' mean you are a failure.