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Doulas and 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 few of my clients choose an epidural.  Call me a lazy doula but I like it that way!

5 responses »

  1. Just stumbled on this while searching doula and epidural – most helpful. As a relatively new doula with a clear preference for natural birth, just took a client who told me outright she wants an epidural. We talked about the ins and outs but she is certain, this being her first, that epidural it will be. I now need to be clear on what I can and should still do to keep her moving along and your piece here has been a help. So, thanks. May we all know how to give the right help at the right time!

    • Omg…..those are my thoughts exactly! I too, am a new doula and have already gone through a mama making the choice for an epidural. After that I just felt like a useless lump of clay, but once the contractions slowed, I found I could be useful in other ways like try to press points that would make the contractions more effective again.

  2. Excellent! I found myself in the extremely strange position of convincing my midwife and doula that yes, really, really, I was okay with getting an epidural. (Long story for why… but basically I was very educated about them, been through the DONA training, thought I’d never…and then my labor happened. Ha!) and they, along with my husband and mom, did a great job in maintaining the space as a birthing place while working to keep from needing a cesarean.

  3. This is a really nice blog. This was so well worded. I hope you don’t mind my sharing with my client as you have stated so clearly all the pictures running through my head as the partner asked “Why a woman having an epidural would need a doula?” Not wanting to be long winded, I don’t think my explanation came out as complete and clear as yours.

  4. Pingback: Is there a problem with doula care?

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