A Doula AND an Epidural? Yep, They Make a Great Team!
So you are planning to get an epidural for your upcoming birth? Great! Epidurals are the most common medical pain relief option used in labor and nationwide they are used in about 65% of births. Here in Utah where I practice as a doula that rate is even higher at more than 80%. Epidurals work well for most women and are relatively safe with major complications rare. So could you still benefit from a doula at your birth? YES! Yes! Yes! Epidurals are great at relieving the pain of contractions, and… well that’s about all! Here is a “short” list of just some of thing things an epidural won’t do.
Epidurals don’t provide a professional’s advice and support just a phone call away 24/7 during your pregnancy. You can’t call your epidural after each appointment with your doctor to have it explain the tests and procedures that were suggested or preformed. Epidurals can’t encourage you to ask the right questions or send you relevant and accurate information if a question or concern arises in your pregnancy. You can’t cry to your epidural, telling it your greatest hopes or fears. Your epidural won’t give ideas for coping with common pregnancy discomforts like heartburn or backache, and your epidural won’t be able to recommend a great photographer or child birth class.
Epidurals don’t visit with you in your home before labor to discuss your wishes and preferences for your birth. Epidurals don’t help you to make a birth plan or help you explore your hundreds of other options surrounding pregnancy, birth and postpartum care.
Epidurals don’t come to your home at the start of labor to offer support and guidance, help you pack your bags and load the car. It won’t know when to suggest a trip to the hospital. Epidurals don’t stand with you while your partner finds a parking spot, or carry your bags so he has a free arm to hold your hand. Epidurals don’t help you get checked in at the front desk, or settled into your room.
Once you are checked in the nurses usually want to make sure labor is well on its way and monitor you and your contractions for an hour or two before admitting you in labor. During this time your epidural is nowhere to be found. Your epidural won’t help you to relax and manage the intensity of THESE contractions. Your epidural won’t walk the halls with you, stopping every few minutes to apply counter pressure, or hold a sick bag, or offer a drink.
Your epidural won’t help to advocate for you. It won’t ask the nurse the questions you wanted answered but are too in the zone to ask. Your epidural won’t remember to give the staff a copy of your birth plan.
Epidurals don’t turn down the lights of the bright hospital room. They don’t bring soft music to drown out the sounds of the hustle and bustle in the hallways. Epidurals won’t draw you a warm bath to relax in while you wait to be checked again, or rub your feet or massage your back.
Once it’s decided that labor is indeed well on its way and it’s time for you to stay and have your baby you can now think about getting your epidural. Hooray!! But it takes time to call the anesthesiologist and sometimes your doctor will want you to wait a bit. If labor has progressed passed a certain point then the chance your epidural will slow labor is less. So you wait and you labor and your epidural is nowhere yet to be found.
Finally it’s time! The anesthesiologist is available and your doctor has given the thumbs up. Your epidural and the sweet pain relief it brings is almost here, but first you must, get an IV started, get into bed, visit with the doctor or Nurse Anesthetist who will place the epidural, sign consent forms, etc. The process takes several minutes and sometimes an hour or more and it’s uncomfortable in and of itself. They have to numb you and place the needle and start the drip and all the while you are still having regular and usually strong contractions but you are asked to lay or sit perfectly still and not to move while your epidural is placed. Your epidural doesn’t help you with this part at all.
AND finally it’s here; your epidural has come to save the day! It and the sweet numbing pain relief it brings are welcomed and wanted. You choose an epidural and now all is well. You are completely free of all pain and fear. You will just take a short nap or watch your favorite movie and then someone will wake you up to let you know that your baby is here.
But you still hurt a little, and your head aches and your shoulders are sore. The epidural usually does a fantastic job of relieving the pain of the uterine contractions, but you are still in labor and your body is tired. Your back and shoulders are feeling the burn from the past many hours of labor and your epidural won’t rub them or apply an ice pack or hot pad.
You must move from side to side in bed every so often and now you have become the tube monster with IV’s, catheters, cords, and monitors everywhere. And you can’t feel your legs well enough to lift your bum off the bed. You call the nurse to come help you turn, but she has other patients and can’t come right away so you wait and you try and wiggle a bit on your own but you’re not sure if you are pulling on one tube or another and so you figure its best just to wait. Your epidural won’t help you to get your tubes under control or to change the wet and bloody pads you are sitting on. So you sit and you wait for the nurse.
You epidural won’t help when the staff rushes in because your baby’s heart rate has taken a little dip. They are busy making adjustments to medication or calling for help and you lay there and worry. Your epidural isn’t right by your head calmly and quietly explaining what’s going on or what might happen next and your epidural won’t turn to your partner and tell him that his baby and his lady are going to be ok and that this is not uncommon. In just a few short minutes everything is back to normal and the staff is leaving, your nurse tells you everything is ok and they will be outside keeping an eye on everything. Your epidural won’t encourage you to ask what HAS just happened or IF it will happen again. Your nurse is happy to answer your questions; she just didn’t know that you cared for a longer explanation, so she sits down and takes a few minutes to go over it, showing you the monitors, your baby’s heart rate, and reassuring you that you and your baby are well.
It’s been several hours now and your epidural is still working great or maybe it’s starting to wear off a bit, who really knows because you see your epidural is not fool proof and sometimes they work well and for the entire time you’re in labor and sometimes they just don’t. You see, your epidural is a fickle friend who can sometimes leave you in a painful and one-sided lurch.
It’s been many hours and daddy is looking a bit worse for the wear. They don’t give the daddy’s epidurals and he has been on his feet and by your side for many hours now, maybe days. Your epidural doesn’t care about him and the staff is busy caring about you and your baby and so daddy just stands by your side woozily holding your hand. Your epidural doesn’t offer to get him something to eat or a cup of coffee and he doesn’t want to leave your side because although the epidural has taken away much of your physical pain it is a poor friend or support. The nurses are in and out to check, but they never stay long so if he leaves your side you will be all alone and sad or scared so daddy just stands and tries not to pass out or puke.
After another quick hand up your hoo-ha you get some exciting news, your cervix has opened up fully and it’s time to push your baby out. Your epidural is still relieving the pain of labor, BUT this part is not easy work, numb or not you still must dig down deep and hopefully when you climb back out you get to hold your baby!! So you push and push and PUSH. Your epidural doesn’t give you any ideas or suggestions. Your epidural doesn’t put a cool cloth or your hot and sweaty brow. Your epidural doesn’t again help you to ask questions of the staff or remind them of your wishes. Your epidural just numbs you, your body, not your mind. Labor and birth are an intense mental and emotional work out too!! Imagine the hormones of 1000 periods and the emotions of your wedding day x5. You need more, much more, than just pain relief. You need information, advocacy, support, and reassurance. No one told you how alone or scared or defeated you could feel while being surrounded by a mess of caring and educated medical staff. They are busy with monitors and medications and vital signs and you lay there and you weep and your partners weeps too because you see this is the birth of HIS child too and he needs all the same reassurance and support and information and that epidural that you got is not giving you ANY of that!! It’s just relieving your pain, but labor and birth are much more than that.
And then your baby is born you are handed this pink and slippery thing and the weight of a thousand worlds falls down on you, and your baby is healthy and well and you are well and the world is good, or is it? You see sometimes all is not perfectly well, sometimes babies need help. The epidural didn’t prepare you for this. What if they must take your baby away for a bit, for tests or assistance? You tell daddy to stay with the baby and don’t take his eyes off her, she needs him more than you do right now and so you lay there and they stitch you up and you wait and you wonder and you cry. Is my baby ok? Is my partner? Am I? Your epidural has made you so numb you can’t yet walk and even if you could they still need to finish your stitches so you lay there and your only support person you brought, your partner, has left with the baby and you are left with your epidural, but it doesn’t talk you through what has just happened or hold your hand or wipe your tears. The nurses would love to sit with you but they are busy and another baby is on the way so they pop in and out to check but they can’t just sit and talk or just sit and be there. So they clean you up and they leave.
Your epidural is starting to wear off now. You are feeling more, but your baby is back! Or maybe she never left. You did it! You gave birth and your epidural is wearing off and the hard part is over.
It’s time to feed your baby, but you see your epidural won’t help you here either. It won’t sit patiently by and help or educate you on breastfeeding. The nurses will come and help, but they don’t have all day. And babies? Well sometimes they need ALL DAY to figure out that first feed. After a while maybe your nurse just suggests you give baby a bottle or two because she is a lazy eater and it’s time to send you to another room. The nurse is busy and just doesn’t have the time to sit and help you breastfeed any longer. And by now your epidural is LONG GONE, it has done its work and it is out of here.
Epidurals won’t stay and help you breastfeed or carry all your bags up to your recovery room. Or take pictures of the birth and the new family. Your epidural won’t sit with you while you pee that first time or help you get into your super sexy disposable underpants or make sure you have something to eat right away.
Daddy has been up as long as you have, but your epidural won’t come to your postpartum room, and fold down the couch and put on clean sheets and make up a bed for him so he can just sit with you and marvel at your new precious little thing.
And your Epidural won’t call you later that day to check on you either. Epidurals don’t stay on call for you. They don’t answer questions about breastfeeding and early parenting. They don’t help you process your birth or understand why things went the way they did. They don’t visit you at home that first week and bring treats or help with the baby or throw in a load of laundry.
You see, during pregnancy, birth, and postpartum, women need a LOT. How to manage the pain of labor is just ONE piece of an incredibly complex puzzle of support. A supportive partner is another. And a doula? Remember all those things an epidural can’t do for you? Well, she can! She can do all that and more – so much more – if you just let her. You may not even know what you will need when the time comes, but your doula will be there through it all, to support and educate and advocate. Doulas are not there just to help with the pains of labor. An epidural can relive that, but a doula, she can do so much more!