Mama Monday - Doulas and Epidurals
As a Birth Doula, I have encountered many questions about whether or not a woman should hire a doula to support her in her birth if she plans to receive an epidural analgesia for pain relief. This is a very good question, and I'd like to offer some information that might help you make that decision if you're wondering the same thing!
The first thing to remember is that a doula's job is to offer physical, emotional and informational support to a woman before, during, and just after birth. Every woman giving birth needs support and encouragement, regardless of her location (home, hospital or birth center), or choices of pain relief during childbirth. Many make an incorrect assumption that doulas only serve women seeking natural and unmedicated births; in fact, doulas serve all women and are especially helpful when epidurals and other interventions are needed.
When it comes to epidurals, there is a myth that a woman will simply not feel any pain. Consequently, one may assume she won't need any support if she isn't in any kind of pain. While an epidural is usually very effective at relieving pain, many women still feel pressure or some level of discomfort during the birth process. It's also wise to consider the time leading up to the point of receiving the epidural - whether labor moves more quickly than expected, or the anesthesiologist takes longer to administer the medication, you may have a period of time where no medical pain relief is available to you. Once administered, it takes about 20 minutes for the medication to take effect and be adjusted properly. In all that time, you may experience both pain and fear, and are required to be still in bed, and a trained and experienced doula who can comfort both you and your partner is indespensible.
Then there are women who have such fast moving labors that by the time they reach the hospital, it is time to push and the time required to administer the epidural simply is not available. This has happened to a dear friend of mine TWICE! Though it was a blessing to have labor progress quickly, she certainly had not prepared for the physical and emotional experience she encountered, and would have greatly benefited from a doula's support!
Epidurals effect every patient differently as well. Some women do not receive the amount of pain relief they expected, whether too much or not enough, while others feel extremely uncomfortable with a feeling of numbness. While less common, it is possible for the epidural to offer only partial, patchy, or one-sided pain relief. Doulas are there to help you feel calm no matter the situation, and are well equipped with alternative methods of pain relief and comfort measures for the duration of your labor experience. This is the main reason I always encourage my clients to prepare for a natural childbirth as a way of backing up any other plan. This way, they have thought about and practiced a variety of comfort measures to put in their "toolbox" in order to prepare for any outcome during the birth process!
Regardless of your choice of pain relief, two things that never change about labor are movement and gravity. Changing positions often and moving through your available space utilizes gravity and helps change the shape of the pelvis to encourage fetal descent and progress labor. If you do opt for an epidural, continuous electronic fetal monitoring is necessary and usually restricts you to your bed. A trained birth doula can assist you with creative ways to change positions and still utilize gravity to make sure labor continues to progress instead of stalling.
Lastly, all women giving birth, unless you require a cesarean section, have to push that baby out at some point! Your labor and delivery nurses and doctor are usually very effective in coaching you to push, but a doula is yet another layer of support. She will have been with you continuously throughout the labor experience whereas nurses come and go, have shift changes, and your doctor will likely arrive only when it's "game time." You will have developed a rhythm with your doula and she will know the best and most effective ways to encourage you, and because you've discussed your needs and wishes with her, she will be familiar with those as well. Doulas are well trained in the anatomy of childbirth and know effective and ineffective ways of pushing. Epidurals often decrease the urge to push and can make it difficult for women to push spontaneously and effectively. Doulas have the experience necessary to help women overcome this pitfall and successfully birth their babies, reducing the need for instrumental and cesarean deliveries.
Benefits of having a doula accompany you at your birth, as referenced in numerous clinical studies, include the following:
- shorter labors with fewer complications
- reduction in negative feelings about the childbirth experience
- reduction in the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
- reduction in requests for pain medication and/or epidurals
As you continue your journey of pregnancy and anticipation of the birth of your baby, please consider these other wonderful resources as you gain information and make plans!
- Epidural Anesthesia in Labor from Midwife Info
- Birth Doula FAQs
- Hiring a Doula in the Tulsa area
- More info on Doulas and Epidurals
Good luck, happy birthing, and feel free to contact me with any questions or if you're looking for information about having a doula at your upcoming birth!
Love and Honey,