Doulas and Epidurals, 7 ways doulas support women with epidurals.

“Do you stay if I get an epidural” is a question I have heard a few times in recent months. My doulas and I have been hearing more and more stories about other doulas who will only support a certain type of birth. While they were interviewing other doulas, several of our clients were told that the doula would leave after an epidural was placed. “There’s nothing for me to do at that point”, they were told. These doulas will only support women who plan for an un-medicated or ‘natural’ birth. Now, I have a lot to say about planning your birth, see last month’s blog, as well as supporting women in ALL types of birth.

It seems to me that many expectant moms also believe that doulas only support women who want to avoid the epidural and therefore think it is not something they would want, need or benefit from. I disagree; ALL women who want a doula can benefit from having one, regardless of where, how and with whom they choose to birth their baby. At BEST Birth Hawaii we don’t advocate for a certain type of birth, we believe in options and respect. We SUPPORT you, in all YOUR choices, without judgement. Our concern is that you have a positive birth experience, one that you look back to with joy and happiness

So, how DO doulas support women who get an epidural?

1. Emotional Support

Labor and birth are not only physically demanding, it is a mental and emotional journey as well. Once an epidural is placed and a woman has gotten comfortable some of the processing of the birth may begin. A doula is there to help her with that. If the epidural was planned she may remind the mom of the next part of labor yet to come and help her mentally and emotionally prepare for that. If the epidural was unplanned a mom may have some negative feelings about having gotten the medication and it is important to start processing that right away. It’s important for moms to be reminded that they are on a journey and that sometimes the road taken is a detour, and that’s ok.

2. Physical Comfort, the epidural may not work fully

Once the epidural is placed it takes a few minutes for it to work fully. The medication spreads through the dura (the space around the spinal cord where it is placed) by gravity. So helping mom rotate a few times can help get her comfortable everywhere. However, sometimes the epidural doesn’t work completely in all areas (breakthrough pain), on one side, or at all. If this is the case a doula can continue supporting mom and her partner to cope with the sensations of contractions. When the epidural does work well it can be helpful to massage the mom’s legs to help with swelling from the IV fluids. Massaging other parts of her body can help her relax those parts of her body so she can rest better and let go of any remaining tension in her body, which in turn will help the labor process that may have slowed down because of the medication.

3. Positioning

If the epidural does work well, or mostly works, the woman will usually take a nice rest first. Once she is rested it is important to keep changing positions for two reasons. One, babies ususally like it better when mom is not in the same position or more than 40 minutes or so. It helps them move down and put pressure on the cervix. And two, the medication works on gravity as mentioned above. A mom with an epidural loses a lot of her mobility and many women need help getting from one side to the other. Also, the use of certain tools, such as peanut balls, can be helpful in keeping labor from slowing down too much.

4. Keeping Company

It takes time to have a baby and often the epidural may slow things down. It can be very helpful for both mom and her partner to have some company during the rest of labor. Sometimes its helpful to talk about other things, sometimes the labor is exactly what she may want to talk about. It’s just nice not to be alone for most couples going through this experience.

5. Advocating in case other interventions come up

In many cases once the epidural is placed other interventions come up. Sometimes labor slows down a lot i.e. contractions start to space out or become weaker and Pitocin or breaking the water is suggested to help the process along. Sometimes babies are letting us know via the heart monitor that they aren’t happy and something may need to happen……. or not. Doulas are there to help navigate other interventions and possible detours. They can help ask questions and process the information, so parents can make decisions that are right for them.

6. Support in second stage, may take longer, or go to cesarean

When a woman can’t feel her legs and pelvis fully it usually makes the second stage, or pushing, a bit more challenging. A doula can be there to help a mom get through it by reminding her how to push without bursting the bloodvessels in her eyes. She can encourage the partner to be involved to the level they previously discussed. When second stage begins it is generally an exciting time, but it can take a while and sometimes frustration takes the upper hand. A doula can remind mom that she is doing well and that things are normal. If they are not and an assisted delivery (vacuum) or cesarean becomes necessary, her emotional support is invaluable.

7. Support immediately postpartum

Once baby is born a doula can take those very first pictures, keep an eye on what’s going on in third stage with medications and the placenta. She can remind mom about breastfeeding, if she so desires, and to be patient with that. She can guide mom and baby to a comfortable position, so they can rest and bond. She can get some well-deserved food for both parents before leaving them for personal bonding time as a new family.

Doulas are your labor buddy. They are your knowledgeable friend who is there to make sure this day is the BEST day in your life. What was your birth like? Did you have a doula, did you get an epidural? If you're still pregnant, what are your thoughts? Comment below and have a conversation about it.