Doulas and Epidurals

By Sasha Weigel, RN, CD(DONA), CLC

Have you ever thought you’d like to work with a birth doula, but hesitated because you knew you wanted to have an epidural? Today on the blog, we have Sasha Weigel, one of Baby Caravan’s Birth Doulas and our Doula Coordinator sharing with you how birth assist moms who have an epidural during their labor. 

 As you may know, a birth doula serves a mother and her partner. That is her singular role. This means that she is at service to the mother’s judgment. Her place is never to judge one way or another how a mother acts, reacts, or what she needs during the labor process. If the mother desires an epidural, this is a good and appropriate decision for her, because only she knows what her body and her baby need. She should never be dissuaded from using pain relief medication if this is her wish. The only context that this might be acceptable is if the mother has pre-arranged with her doula to enlist the doula’s help in avoiding an epidural when labor becomes more challenging. However, even during this context, if the mother changes her mind, the doula will never hold her to her original intentions. The doula is well aware that wishes an intentions change very often during the course of labor. The doula’s goal is always to be flexible, accepting and validating of any decision the mother makes along the way.  

Epidurals can be extremely effective tools if this is something the mother choses. Sometimes labor can be very long and an epidural can offer the mother the opportunity to rest and recover before the pushing phase begins. By allowing for this therapeutic rest during labor, the mother and her partner may discover that their enjoyment of the process, and their ability to be present for it, increases. Sometimes a mother has a hard time letting go and surrendering to all of the physical changes that her body is undergoing. Her body may feel clenched and tightly wound with fear. In this case, an epidural may be the perfect tool to allow her to relax and release.  

There are many ways the doula can support a mother who has chosen to have an epidural. Because the mother must remain in bed, the doula will remind and assist her frequently to turn from side to side and hands/knees if she is able. It’s important to keep changing the mother’s position so that the baby is aided in his/her efforts to descend and negotiate the pelvis. The doula will help the mother adjust her hips in such a way that her pelvic outlet stays open and is not compressed. Massage can feel wonderful during this time, as the mother is less consumed with coping with the sensations of contractions and is instead able move into a deeper place of relaxation. During this time, doulas also employ acupressure, aromatherapy, the rebozo and other tools and tricks that aid in the mother’s relaxation and process of letting go. Sleep, deep breathing and meditation are all ways to invite the body into a more accepting state so that labor can move fluidly. The doula can help make suggestions, guide and encourage all along the way.  

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Spoiler alert: below is a graphic description of the administration of an epidural in labor: 

Some locations require that only one support person is allowed in the room during the administration of an epidural. If only one is allowed, generally the partner will stay with the mother, although this is up to the mother to decide. The reason for limiting the number of people present is because the administration of an epidural is considered a sterile procedure. The mother will be positioned sitting at the edge of the bed or lying on her side. The partner or doula will stand or sit in front of her. The Anesthesiology team (usually two MDs) will situate themselves behind her back. They will ask her to bend forward into a slouching position like “an angry cat” that arches its lower back. She will need to maintain this position during the procedure. This allows the spaces between the vertebrae of the spine to open. The mother’s back will be cleaned and then numbing medication will be injected around the lower spine. These injections will feel like a pinch and a burn but then very quickly the discomfort subsides.  

When the mother feels adequately numb in the area, an Anesthesiologist will insert a large-bore needle between her vertebrae into the epidural space of her spinal column. The mother may feel some pressure and potentially more sensation on one side of her body than the other. Occasionally she will discover a metallic taste in her mouth. Through the needle, the Anesthesiologist will thread a tiny flexible plastic catheter (tube) into the epidural space, after which he/she will remove the needle, leaving the catheter in place. Once the needle is out, the Anesthesiologist will begin administering medication through the tube. The medication contains a mixture of Epinephrine, Fentanyl and Bupivacaine. The tube will be taped down to the mother’s back and she’ll be asked to lie down, if she isn’t already, so that the medication can begin evenly distributing itself. The Anesthesiologist will then attach the tube and medication to a pump so that the mother receives a constant infusion of the medication. This infusion will continuously be administered at the same rate over the course of as many hours as is needed. As a result, the mother will feel a steady state of pain relief. 

The whole procedure, including set-up, generally takes no more than 15 minutes. The mother should feel relief within 30 minutes. She will be given a small button to press in case she requires additional relief. It’s called a PCA button: Patient Controlled Analgesia. Each time she presses it, she will receive a small bolus of the medication. She has the option of having the epidural pump turned off at any point in time. Sometimes the mother requests this during the pushing phase so it’s easier to feel when she’s having a contraction. After the mother delivers, the pump is turned off. Sensation returns over the course of an hour or so once the pump has been stopped. It takes about this long for her legs to feel normal enough to leave bed and walk around.    

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Did you have a doula and an epidural? How was your experience, we’d love to know! Feel free to comment below. 

Jen Mayer