Doulas- When a Dr tells you to hold up a women's legs...

[rachelagain]

What do you do?
All the hospital births I have done the Dr wants the women on her back w/ her legs up- and they expect me to hold up the leg on my side.
All my in hospital clients have had epidurals, so they can't use their legs themselves.
I work w/ a low income clinic and help mostly girls who have no support. They choose me so they can have someone there- not because they want specific things during their birth.
What are other positions a women can birth in, with an epidural? And how do I suggest that, since at that point in labor these women will do whatever the dr says and they don't seem to have an opinion.

tia-

[SublimeBirthGirl]

You could suggest side-lying. PRobably more of a focus on prenatal education would be the best route?

[memiles]

I do what the mother wants me to do. For most of my clients who have chosen an epidural, they want either myself or their partner to hold their leg-better me than the nurse that they don't know. If she is side lying, I hold a leg while partner is near her face, or vice versa. If she is on her back and she has a partner/second support person, each of us have a leg.

I generally try to do a few things during the process-I show the partner how to hold her way in a way that isn't going to hurt her later (it's easy to put her leg in some funky angles that will hurt once the epi wears off). I aslo show how to put her leg down while supporting her knee so she can truly relax between pushes. I also encourage mom to hold her own legs with our help.

I actually had a doctor show a client how to push while holding her own feet (think frog legs) while we held her knees, and she loved that. I've suggested it to a few clients since then.

If mom has expressed a strong preference not to push on her back, I encourage her to ask the doctor if she can try another position. I have helped a woman with an epidural pull up to squat (with lots of support from either side), but that was before the doctor was in the room.

[tlcdoula]

Originally Posted by memiles

I do what the mother wants me to do. For most of my clients who have chosen an epidural, they want either myself or their partner to hold their leg-better me than the nurse that they don't know. If she is side lying, I hold a leg while partner is near her face, or vice versa. If she is on her back and she has a partner/second support person, each of us have a leg.

I generally try to do a few things during the process-I show the partner how to hold her way in a way that isn't going to hurt her later (it's easy to put her leg in some funky angles that will hurt once the epi wears off). I aslo show how to put her leg down while supporting her knee so she can truly relax between pushes. I also encourage mom to hold her own legs with our help.

I actually had a doctor show a client how to push while holding her own feet (think frog legs) while we held her knees, and she loved that. I've suggested it to a few clients since then.

If mom has expressed a strong preference not to push on her back, I encourage her to ask the doctor if she can try another position. I have helped a woman with an epidural pull up to squat (with lots of support from either side), but that was before the doctor was in the room.

I agree - I do what the mom wants me to do.

I actually had a client do this frog position by herself. She was struggling with pushing and suddenly she grabbed her feet and pushed and out came the baby. Later she said she did the same thing with her two dds but she forgot about it (I was not her doula before).

[bobandjess99]

Yep, I'd focus on the education before hand part. Perhaps start bringing it up during your meetings. "so, if you choose an epidural, your birthing positions will be limited...etc" so they are informed.
i have had SCADS of moms who, when making a birthing plan, check "i want to be free to move around" and also check "i want an epidural" they are COMPLETELY blown aay when I explain why that will be impossible.......

During the actual labor, I would do what the mom wants, always. *IF* the doctor were to give me a direct order, I would re-direct it to my client (you know, the one "in charge") and be like " Jane, the doctor feels your legs should be up in the pushing position now, would you like me to hold your legs or would you like me to do something else?"

[SublimeBirthGirl]

Yes, the information commonly available is so horrible. I wouldn't assume just because a mother is low-income or young or alone that she doens't have the capacity to make informed decisions. I'd put together a little info packet about various interventions, risks and benefits of pain meds, and alternatives for dealing with contractions. These women may not think to question their doctors, and by the time they're flat on their backs and pushing uphill it's a little late to give them the information.

[rachelagain]

Originally Posted by SublimeBirthGirl

Yes, the information commonly available is so horrible. I wouldn't assume just because a mother is low-income or young or alone that she doens't have the capacity to make informed decisions. I'd put together a little info packet about various interventions, risks and benefits of pain meds, and alternatives for dealing with contractions. These women may not think to question their doctors, and by the time they're flat on their backs and pushing uphill it's a little late to give them the information.

You're right, a packet would be a good idea- I will start working on that.
I have to say, that I don't assume she doesn't want to make informed decisions, but by the time they come to me they have already decided what interventions they want. This last week, one girl gave birth- but doesn't want to breastfeed because she has her nipples pierced and doesn't want to take that out.
I gave her all kinds of info on how you can still bf, how good breastmilk is for baby, etc. but to no avail.

Perhaps I don't make the point clear enough because I am trying so hard not to give advice/push her into something I want.

I have also had girls that don't want to know any of the bad side to their decision- effects of epidural on baby, etc.