Doulas when using an epidural

[saralm]

Hi All,

I have been talking to my sister-in-law about her birth (she is now 22 weeks) and she says that she hasn't decided whether to have an epidural.  I have been saying for a while that I really recommend a doula.  I had no epidural and had a doula - I was very happy with my experience.  I would love some help convincing her that a doula is worth it - scientific studies would be best but anecdotal would help too.

Can anyone point me to any studies that show that outcomes are also better for mother and baby, even when the mother had an epidural?  Alternatively, how effective do those who are doulas feel they can be when the mother has an epidural?  Does it make any difference to you?  Are there any moms out there who had epidurals and doulas?  Was it worth it to pay for the doula? 

Thanks

[starrlamia]

Ive been at 2 births with clients who had epidurals (non paying though, volunteer position) and it can be really beneficial. For one most places will not give you an epi before 4cm's or after 8cm's, so before "active" labour some women need the support, or if they are trying to go as long as possible before getting one they may also need the support. I also find it is nice to have someone (doula or family etc) to support mom during the pushing phase, some places will taper off the epidural somewhat when nearing full dialation, and nurse and doctor are at the business end of things and mom may needs some encouraging words or direction. However if someone doesnt want a doula, they dont want a doula, i would encourage a supportive person be with them during labour to reassure them if needed, or if they feel they cannot cope.

If you google doula benefits you will find oodles of information and studies.

[rachieface]

Originally Posted by saralm 

Hi All,

I have been talking to my sister-in-law about her birth (she is now 22 weeks) and she says that she hasn't decided whether to have an epidural.  I have been saying for a while that I really recommend a doula.  I had no epidural and had a doula - I was very happy with my experience.  I would love some help convincing her that a doula is worth it - scientific studies would be best but anecdotal would help too.

Can anyone point me to any studies that show that outcomes are also better for mother and baby, even when the mother had an epidural?  Alternatively, how effective do those who are doulas feel they can be when the mother has an epidural?  Does it make any difference to you?  Are there any moms out there who had epidurals and doulas?  Was it worth it to pay for the doula? 

Thanks

Hi Saralm,

   Here is an abstract from one of the studies on doulas: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595013/

"Results confirmed that support by doulas during labor was associated with a significant reduction in cesarean birth and pitocin administration."

So, if your SIL is interested in avoiding a c-section or pitocin, then a doula is a great option!  In addition, she may not have considered all of the practical aspects of birth if this is her first child.  If she has a looong labor and her partner is exhausted/starving/needs to run out for some reason, then she is not left alone without support.  In addition, I frequently see "breakthrough" pain that can happen in random spots even with an epidural; it is no fun.  During those times, mom can use help working through the discomfort.  Finally, remind your SIL that so much of what a doula does is emotional, rather than physical.  A doula will remind her that her labor is going the way it is supposed to, and that she can do this. 

Hope that helps!

[Beccadoula]

I always recommend that my clients look into the pros and cons in books like Mothering the Mother and Gentle Birth Choices and The Thinking Woman's Guide.  Many women are really scared of the pain - to the point that they don't think about other options, when they have the alternatives laid out and they understand clearly what the problems can be with the epidural - often they will change their minds just with a little more information and confidence.  AND - when talking to them it is also good to communicate that they will likely be in a lot of pain during the proceedure...little known fact.  I had a client who's worste experience in her labor was the getting of the epidural - she was litterally screaming for him to stop and he wouldn't.  They poked her 8 times and her doula could do nothing because her doula had been asked to leave for the proceedure.  She actually had birth trauma from her epidural provider!  When I came back in the nurse was deadfaced and the couple were both crying - I mean sobbing.  NOT all epidurals go like that, but it is worth while to know that it is possible.  In the end, you still have to respect their choice and support it though.  Some times the reasons for needing to get an epidural are far more complex than we can possibly understand on the surface.  If you can convince them to wait for a 5-7 cm dilation before getting it they will be far better off in most cases.  You can do that by talking about it beforehand, but also during labor when they find out they are a 4 - ask them if they can possibly wait another hour...in an hour ask the same question again.  An epidural can be amazing for a mom who has had a hard labor and doesn't seem to be getting anywhere...I've also seen it stop everything and been soooo thankful that I had my client wait to get it because she was able to push her baby out without contractions!  If she hadn't been almost complete at the time of the epidural she might not have had a vaginal birth.

[saralm]

Thanks for the thoughts!

[mama_ness]

I have had a few clients get epidurals and I don't think my job ended when that happened. If I had a client that knew they wanted an epidural, I would want to have a discussion about what an epidural means at various stages of labor. If she gets the epidural at 4 cm, she will very likely need pitocin. How does she feel about that? Let's talk about the risks and benefits of an early vs later epidural. If she is willing to wait until 6 or 7 cm, what techniques would work to help her stay comfortable? Does she like water? Massage? I can help plan a strategy that allows for pain medication but also reduces the risk of other interventions. Obviously, it's impossible to plan how our bodies will respond to any intervention, and I make that very clear to my clients, but I believe in supporting their informed choices. 

Typically for me, this is what an epidural birth looks like: After the epidural, the discomfort is still there, it's just less intense. I usually send the partner to eat if he needs to and I encourage him to take a whole 20-30 minutes if he needs a mental break or if it's been a long birth. I help the mama process what just happened. Sometimes they feel guilty for getting the epi, sometimes they just want to describe every new sensation they are feeling to someone. Whatever they feel, they almost always want to talk about it in some capacity. Then they usually sleep and i go eat or get a coffee. Once mom is alert again, I work on gentle counter pressure, either on the hips or sacrum depending on her position, keeping ice cups full, encouraging snacks if the hospital "allows" it, etc. They still have tons of questions that need answering... even having someone in the room that knows how to turn off the alarms, adjust the volume on the heart monitor, etc... is so helpful so that are not having to call a nurse in all the time. 

Of course, extra encouragement during pushing is great and if anything is happening that is scary or confusing during this time or immeadiately after, it's nice to have someone who is focused just on the parents emotional well-being. Often times, they are completely ignored and no one is talking to them if the baby needs help or there is too much bleeding or whatever. And then there is the breastfeeding and postpartum support that most doulas provide. 

Hope this is helpful! 

[olw3k]

when my clients have chosen an epidural, my role really switches to the emotional side of things... like keeping them engaged in the process of labour and connecting with their body and baby, both of which are still working hard... instead of checking out and watching TV, for example... same goes for working through the emotions of getting an epidural, especially if they hadn't planned to... there's also still lots i can do to aide positioning as well...

Penny Simkin gives a great presentation on supporting women with epidurals: http://www.pennysimkin.com/articles/Supporting_the_Woman_Epidural_Complete3-06.pdf

[Erin77]

I had a doula and an (unplanned) epidural, and I am so happy my doula was with me. She was a lifesaver.

[Redmom]

I had a doula and an epidural.

Since it was my first pregnancy, I did not know how the pain would feel and decided during the labour (whilst we were still at home) to get an epidural.  Once at the hospital, it took another 4 hours to get the epidural because the doctor was attending to many c-sections that night.

So from a comfort/pain relief perspective, the doula was invaluable to provide these to me up until the epdiural came.  Also, by the time I got the epidural I was close to transition, so I felt the pressure of the contractions even though the pain was gone.  The doula provided massage and counterpressure during this time.

The doula helped me establish breastfeeding with my baby as soon as he was born.

Also, I felt like the hospital staff left me alone to labour in peace, which I was happy with because they had no empathy or bedside manner at all.

My doula provided important emotional support to me through the birthing experience, and I felt like I was not alone.  Her presence was very important to me.

Above all, you just do not know what will happen during labour.  eg you may go in thinking you won't want an epidural but change your mind, or vice versa.  I think if you decide on a doula, they will be helpful for you no matter how your labour and birthing experience unfolds.

[BM Doula]

I am a doula, and I recently attended to a mother who had an epidural very early on because she had sciatica and very severe back problems. She and her family all told me what a great help I had been during the labor. The mother had *upper* back pain that I massaged quite a bit through her labor, AND she felt her sciatica through the epidural! You never know how well those things will work. Sometimes epidurals don't even work at all.

I also knew exercises to help the baby to drop when the labor was slowing, and I had things to help with her nausea and blood sugar.

When you get an epidural early on in labor it can increase the chance of a malpositioned baby, and that can lead to more cesarians and more forceps/vacuum deliveries. Doulas can help you get the baby to drop, even when you are confined to the bed.

Doulas really are a must for birth, no matter what you're planning!

[Spring Lily]

I had a doula and ended up with an epidural. It was not planned. My labor was so stressful and scary at times (there was one point they almost rushed me out for a c-section) that I felt like my doula was essential. When things got scary I was so exhausted and just started saying "yes" to the doctors, but my doula had the presence of mind to continue to advocate for me and ask questions that in my right mind I would have been thinking of myself. The hospital staff was very respectful of the whole process, but it's sure nice to know that if anything doesn't go to plan that there will be one calm-minded person to speak up on your behalf.

[CrazyCatLady]

I've had two natural births and two that included epidurals.  I think I benefited from a doula more during the epidural births.  For me, epidurals and being chained to a bed is some kind of mental torture.  My doula's were very important for keeping me calm, distracted, and focused.  I had some kind of serious dry mouth from the meds and my poor doula had to feed me ice chips almost non-stop.  They helped hold my legs while I pushed and they kept me motivated when after 26 hours and I was just feeling done.  I also have a fear of vomiting and having a doula there was great because it was someone I could whine to and she would kind of mother me in a way that I needed and my family couldn't/wouldn't do.  And since my labor was 26 hours, the doula was essential for giving my dp breaks!

So I definitely recommend a doula, even if planning on having an epi.  My doula also would have been a lifesaver had I needed a c-sec.  I would have had her come with me instead of my dp.  She was that good at her job, I couldn't have done it with out her!

[pokeycip]

The Doula Book, which is just out in a new edition, cites many studies that show the benefits of using a doula.

http://www.amazon.com/Doula-Book-Companion-Healthier-Lawrence/dp/0738215066/ref=sr_1_1?ie=UTF8&qid=1330625323&sr=8-1

[AndreaJay]

I'm responding as a mother who experienced having both a doula and an epidural. 

I would never give birth without a doula.

My doula provided me with care prenatally, during labour and delivery, and post-natally, and it all was invaluable. 

I could rave about her for days, but to keep from being too wordy, here's the gist:

-She visited my partner and I a few times throughout the pregnancy to talk about our philosophies, plans for birth and beyond, etc., taking some of the fear of the unknown out of the whole experience. -She stayed with me through 17 consecutive hours of the labour -Early on, helping me with pain management, massaging me, helping me reposition myself, drawing a bath for me, photographing the labour experience. -Post-epidural (which was in place for 3 of the 17 hours she was with me), she helped a shaky-legged me (walking-epidural) to the bathroom, she would fetch food and water for my partner so he didn't have to leave my side, she'd report to family with updates, she kept me company and continued easing my mind with some nerves surrounding pushing and really finally meeting the babes! -She took pictures throughout us pushing, helped to hold baby #1 (twins) while the second was born. -She stayed to ensure we were settled and helped us keep an intimate and private environment for ourselves until we were ready to greet the pouring-in of family members. -She stayed with us at the hospital until we were sure breastfeeding would go well. -She provided us with a few visits following the birth, brought little gifts for our boys, offered to make a meal or two, brought us a beautiful birth slide show with all of the photographs she took.... AMAZING! 

The plain and simple of it is...

There is so much more to having a baby than pushing, and likewise, there is so much more to a doula than someone to help you push! Look at the grander scale, and recognize how enriched your whole experience can become with the extra assistance. 

Cheers!

[amberbirthdoula]

Sometimes I'd say you need a doula MORE when you're having an epidural because you can no longer really follow your instincts in terms of moving around, eating, drinking etc…so it helps to have a doula there to encourage you to move, suggest positions & help you move to them despite the epidural. A doula can also help keep the focus on mom. As others have said, once the epidural is in people tend to leave, watch the monitor more, turn on the TV etc…this is all fine if that's what the mom wants, but a lot of times I've had clients with a lot of questions. Once they are comfortable with the epidural they can express fears about pushing, excitement for meeting their baby, etc… and that can be extremely helpful. 

Hope your sister-in-law decides to hire a doula---she wont regret it! :)