Doulas and Epidurals
By Jennifer Vanderlaan
Professional labor assistants, doulas, are popular companions for the expectant family who is attempting a natural childbirth. What if you are not interested in natural childbirth, is a doula still valuable for a family who knows they want an epidural?
The administration of an epidural requires you to sit without moving for several minutes, and generally through a few contractions. Having a doula, who is both familiar to you and experienced with the procedure, can help you remain calm and relaxed during the placement of the catheter. This can help the anesthesiologist achieve a good placement faster, allowing you to have the comfort of an epidural faster.
After the epidural has taken effect, you will be greatly limited in your ability to move. However, movement during labor is helpful for getting the baby lined up properly and keeping you comfortable. A doula can assist you as you change positions to help keep you comfortable and to keep labor moving as quickly as possible. A doula can also help you continue to use positions and techniques to turn a posterior baby.
Many women do not anticipate the full extent of interventions involved in an epidural. In addition to the catheter in the back dispensing the medication, an epidural comes with IV fluids, continuous monitoring and monitoring of blood pressure. It is common for women with epidurals to also have artificial oxytocin, bladder catheterization and oxygen. A doula can help you understand the interventions being used, and can give suggestions for techniques to help avoid interventions you would rather not have.
Most women find the pain relief from an epidural is more than adequate for them to handle labor, however some women find the epidural to be ineffective or only providing relief in one area. If an epidural does not work right at first, a doula can help you clearly communicate additional pain management needs to the hospital staff. A doula can also assist you through non-medical pain relief until the anesthesiologist is able to make necessary changes in medication placement.
Unexpected Side Effects
Rather than a type of medication, epidural refers to the placement of the medication. Because of this, you may experience any number of side effects depending on the medication used. These side effects range from itchiness and shivering to nausea and fever. Doulas are prepared to assist you in managing any discomfort from these side effects.
In addition to the minor side effects, epidurals are associated with a slower rate of labor and a higher incidence of instrumental delivery. A doula can assist you in continuing a normal labor by helping you maintain movement of your pelvis and adjusting to positions that use gravity to open the cervix. A doula can also help you prevent a sore back after an epidural by gently helping you through these position changes.
A common problem with epidurals is the mother’s inability to push effectively. Two issues work together to make pushing ineffective. One is the mother’s inability to feel her muscles working. The other is the way the epidural prevents the normal increase of oxytocin when the baby’s head puts pressure on the pelvic floor. A doula can assist you if you are unable to push in several ways.
One option is for the doula to assist you in letting the epidural wear off so you can feel the contractions and gain some control of the pushing muscles. As the epidural wears off, you will once again feel contractions and need to work through them without medication. Another option is for the doula to wait with you until the baby’s head can be seen, then begin the pushing phase of labor. This prevents you from having to let the epidural wear off, but does take time. If pushing is still not effective, a doula can help you change positions so the baby is in a better position to be born.
There is a very real increase in chances for a cesarean when a mother uses an epidural. This increase comes from the slowing of labor, which may be called failure to progress, and the interactions of the medications, which may cause the baby’s heart rate to drop. A doula can help you avoid a cesarean by helping prevent as many interventions as possible.
Research has shown having a doula decreases requests for medication, need for interventions and even decreases the need for cesarean. Hiring a doula can help you to put off having an epidural as long as possible, minimizing the impact it will have on slowing your labor. A doula can also help you continue to work with your labor to prevent the need for other interventions including a cesarean after an epidural takes effect.
In about 90% of cases epidurals are able to provide the laboring woman with as much relief as she needs to cope with the pain of labor. Many women find the attitudes of hospital staff change when they receive an epidural, and even family members and loved ones change their behavior once the “pain” is gone. But giving birth isn’t just about getting through each contraction. Having someone who understands what is going on with you emotionally can be very comforting.
Doulas understand the fear of becoming a mother, or becoming a mother again. Doulas do not forget you are in labor just because you are not in pain with contractions. Doulas pay attention to you, not the monitor. Doulas can answer questions about what is happening. Doulas can hold your hand during vaginal exams and other procedures that are uncomfortable even with an epidural. Doulas can cry with you, laugh with you and listen to you no matter how long your labor takes. A doula’s job is to simply be with you, and that job is equally important whether you are feeling pain with contractions or not.