doulas - epidural birth

[snugglebug14]

I was at my first birth where mom ended up with an epidural and I was a bit at a loss. I knew going into it that mom may end up with one. Two nights ago she went to the hospital becuase she was having cramps an insisted it was labor (i didn't find out until the next day). When they did final admit her she was defiantely in early labor but she was already struggling through contractions. By the time active labor REALLY hit she couldnt handle. I was able to work her through contraction for half and hour or so and then she insisted on needing an epidural. I had to let her make her own choice. (She also had extremely unsupportive family in regards to having a natural birth but that's a whole other issue that I DON"T want to get into) So she finally ended up with the epi an slept through the rest of labor so I couldn't do much for her. Then during pushing it was hard to know how best to support her. The nurses/OB were basically instructing her to do "purple pushing" and wouldn't let her make any noise.

So....when a mom has had an epiural what kind of support do you offer especially during pushing?

[courtenay_e]

While she's pushing I sit up by her ear and I whisper to her how beautiful a job she's doing, how awesome her body is, and that she'll be holding her baby in her arms soon. It makes a huge difference in what many mothers remember when they're being shouted at to purple push. Over and over again in a hospital setting after the birth, I've been thanked profusely for being the quiet voice of support for them. I think, too, that being quiet actually gets you the most attention...when a woman is pushing, she often blocks out the cacophany around her.

If she's "allowed" to take them I'll give her ice chips or water between ctx, as that is refreshing. I'll give her a cool cloth for her neck or head, if she feels that helps, as well.

Really, though, the emotional support is what I believe to be the largest/most important job of mine at that point, especially after getting so much feedback to support that.

[Eli's_mommy]

I think it's also good to encourage her to switch sides often while she's still laboring to encourage the baby to come down.

I agree that just supporting her and reminding her she did a good job is very important also. I think especially a mom (and maybe not in this situation) that really DIDN"T want an epi but ended up with one. Remind her she's still a fantastic birthing goddess and doing wonderfully

[mamallama]

It's important to remember that with the epidural, a lot of moms don't even know when they're having a contraction. They don't have the urge to push. In this case, directed pushing might be necessary. It is certainly necessary if she wants to get the baby out before the ob loses his last shred of patience.

You can support the mom by helping her find a rhythm. Quietly talk her through each set of pushes. "Ready, deep breath, go....Deep breath, go again....deep breath, one more...good. You're working really hard. Rest now. Let your head fall back...." Most first time moms with an epidural need to push hard for a good long time before their babies are born.

Sure, maybe you'd rather see her squat and give a primal roar as the baby slides out into her own hands, but that's just not going to be the case every time. In fact, most of my clients didn't see that kind of birth as a goal.

[MidwifeErika]

I actually find the support I give during an epidural birth isn't all that different. It is mostly me being the friendly face in the room that is helpful to a mom. I just tend to reassure her about what is going on. If she wants to sleep for a bit, I just sit by her side and read or knit and just wait for her to wake up and see if she needs anything.

During pushing, I think it is really important to let a mom with an epidural what is going on. I try to let her know what I see or notice. If I can see she is pushing really well, I let her know. If the baby's head is starting to become visable, I tell her exactly what I can see in hopes of keeping her feeling really connected to the process as well as giving her some motivation.

[snugglebug14]

i called this mom last night to check in and see how things were going and she thanked me so much for all my support saying she never could have done it all without me. Then it really hit me, I felt like I had let her down because I couldn't come up with a way to get her through the contractions. I felt like my bag of tricks that use to feel so full was suddenly empty. I was having a really hard time with feeling like I let her down. But, I realize now that she had exactly the birth that she wanted to have. That for her, getting the epidural was not a disappointment or let down. The whole birth was a lesson for me throughout that this is 100% about what mom wants out of her birth. I believed that going into it, but trying to actually balance her expressed wishes prior birth and her desires in birth was a bit of a lesson for me. Thank you so much for everyone's advice. Really, I did a lot of those things kind of without realizing it I guess.

[3daughters]

I also find that once mom has good pain relief the family members like to take a break from the L&D. I will stay with the mom so she won't be alone.

I'm also available to answer questions and make suggestions that will make mom more comfortable. Another thing is that the parents tend to be timid when dealing with the staff. I encourage them to speak up and make requests i.e. for a position change or a bolus. I've had moms that were afraid to page the nurse even when they felt pressure since they don't want to "bother" them.

[kltroy]

I think that remembering this is about the MOM's birth experience - not what you think her experience should have been - is the most important thing to remember. It sounds like you did a great job. Even when mom's idea of a perfect birth isn't the same as yours, your job as a doula is to make sure she is feeling supported and positive. I think it can be tough - as you mention here - when you feel like you've let her down. But your preception isn't the same as hers.

[Mama2Xander]

This is a link to the handouts/overheads from Penny Simkin's presentation on supporting a woman with an epidural:

http://www.pennysimkin.com/acticles/...mplete3-06.pdf

Some of it might not make sense without *hearing* the presentation as well... but hopefully there will be some info in there that you will be able to use!

[3daughters]

Thanks for that link. A lot of valuable lessons to learn from Penny's articles!