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 her partner 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.  Her partner 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 partner 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 her partner could read a story out loud to the baby.

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