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What does a doula do? #3 Epidurals

What does a doula do when her client gets an epidural?

a) She picks up her aromatherapy and her rice sock and walks out the door saying, “good luck with that, sister.”

b) She orders a pizza and curls up on the couch with a fashion magazine.

c) She gets down to the business of minimizing the cascade of interventions to follow.

I hope you guessed “c.”

Most of my clients have unmedicated births.  It isn’t a bragging point.  Women who expect a natural birth, make careful decisions about birthplace/care provider, and surround themselves with a good support team easily have such a birth.  Afterall, and you may have heard me say this a time or two, birth is a normal bodily function designed to work. 

Still, epidurals happen.  They happen for various reasons.  Sometimes they accompany the not-so-natural contractions created by pitocin.  Sometimes they offer the mom a last-chance before cesarean in a long labor.  And occasionally, I have a client who plans to get an epidural but wants to wait until later in her labor.  Whatever the reason, epidurals happen.

What do I do when a client gets an epidural?

First, I watch her emotions.  Is she disappointed?  Angry?  Does she need to talk?  Maybe she doesn’t feel like talking but would welcome some pampering.  I might bring her a toothbrush or braid her hair.  Freshen the room.  Whatever the vibe, a doula’s first job is to satisfy the emotional needs of her client.

Then I usually send dad out for a break or a meal. 

And I work out a plan.  In my head; not on a whiteboard or anything!  Mobility is most crucial.  Mom needs to move into different positions regularly.  This movement will help her baby continue his rotations.  Some nurses are uncomfortable with moving mom onto her knees (forward leaning) so I carry a picture to demonstrate.  You can see in the picture here that the mom is able to drape over the bed which is almost in a complete slant.  Dad was supporting by pushing against her lower back.  When mom is in this position, I am even able to sift by standing on the bed.  I remember a nursing student walking in while I was standing on the bed sifting a client with an epidural.  She was shocked.  Curiously so.  And stayed to learn more about sifting.  In addition to moving her onto her knees, I’m also shifting her from side to side every 30 minutes or so.     

I’m also watching for her contractions to space out which sometimes happens with an epidural.  If they do, I hit acupressure points or encourage her to do nipple stimulation to get them going again.  While I’m not usually comfortable with intervening much in labor progress, all bets are off when we move into medical intervention territory.  If the epidural causes labor to stall, then pitocin will surely be introduced.  Pitocin can cause fetal distress which, of course, can lead to a cesarean.  My main goal once a client gets an epidural is cesarean prevention. 

Finally, while her birth plan may have hit a bump, I work to keep the environment woman-focused.  In my experience, it seems that the medical team acts differently with a medicated patient.  There is more chit-chat, the lights come on, the traffic increases, the door gets left open.  Nurses and doctors think they can do vaginal exams anytime they please.  She is now continuously monitored by a machine.  She has a bladder catheter, IV, and blood pressure cuff.  Even the dad can get caught up in watching the contractions on the monitor and reporting them like a sportscaster.  “Wow, did you see that one?  It was a whopper!”  I might hit the silence button on the monitor or cover it with a towel.  I’ll encourage my family to stay focused on their baby instead of turning on the TV.  Maybe I’ll do guided imagery or suggest dad could read a story out loud to his baby.  

So while it might seem my job would be easier when the epidural enters the scene, it isn’t.  Nope. 

Meanwhile, I am happy to report that none of my clients this year have had an epidural.  Call me a lazy doula but I like it that way!

7 responses »

  1. Great post, Julie!

  2. And this is why I advise friends to have a doula whether they are going for a natural birth or not. A doula is invaluable for any birth.

  3. Great post! I love that the way you laid everything out here…very informative and insightful. And so sad, yet true, that the atmosphere shifts away from being “Woman-Focused” once mama is medicated. Oh, the roles of a doula are un-ending! I am so grateful for all the good doulas out there (have experienced 2 othem myself) and I’m keeping my hopes set on one day starting down the doula path as well.

    Blessings to you as your support birthing women!

  4. Wonderful post! Everything you said is so true. I have yet to meet a nurse or doctor who welcomes the idea of getting a mom with an epi on her knees in bed. Carrying a picture of it is a great idea.

  5. I have ended up being the “labor coach” for 5 babies’ moms in our extended family, and there were two moms where the epidural did not work and it was awful. They were not prepared to go without an epidural and everyone seems to expect it to work 100%! Oh they were miserable and it made their labors longer (I’d see the contractions slow waaaay down after getting the epidurals or being “topped up”). They were starving after not eating for hours and hours, wanted to drink,…I kept offering food and drink when no one was in the room but because the nurses/OB says not to, they will not.
    My favorite was my 19 year old neice having her second child, refusing pitocin, completely natural(besides the sOB cutting her after being told not to)(and you’d probably know this OB if I named him), it was so wonderful and magical. She did not let go of my hand until the end 🙂 I still get teary-eyed thinking about that birth.
    I am planning on becoming a doula and LC at some point. I was going to work on it this year, then we decided to have another baby instead so I’m putting it off. What’s exciting to me is that with the last two births I’ve been at, I was able to tell by the monitor when it was *time*…and each time I thought it was that time, all the nurses and the OB came in and broke the bed down and yelled to push and babies were born. I’d love to be at a homebirth though, or at least a quiet, laid-back hospital birth.
    Sorry I get off-topic, my mind wanders!

  6. OH! I remember one thing I wanted to say…the last birth I was at, the mom had the epidural that wasn’t helping her. Her legs were weak but she was still in alot of pain. She wanted to move around so much and I was trying to help her sit up some and put some pressure on her lower back(way below the epidural needle, I was not putting anyone in danger here) and the nurse ran in and asked, “What are y’all doing now?” and made her lay back down, on her back. I’m like, “Her back is hurting and I’m trying to help her.” But they do NOT like if you are not on your back or at the most, they allow a tiny bit to the side. The mom commented that she should have taken some kind of childbirth class and the nurse told her that wouldn’t have helped her, that birth hurts. (duh…that’s why we learn to deal with the pain best we can and not stick things in our backs to numb us.)

  7. Pingback: Preparing for Birth: Birth Support » A Little Bit of All of It

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