Doula's: how do you know when to "give in" on the epidural?
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I don't understand the question. If one of my clients said the above to me I would say "Great" and perhaps talk about the pros and cons of various interventions and how she saw herself coping with pain. The choice to have an epi is hers though, not yours, so I don't get what you mean by "give in". Perhaps I am reading it wrong?
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I ask about her Simkin's pain preference number beforehand and we talk about what she would want me to do if she asked for one. If she wants me to try and help her hold off or distract her, I'll do that. If she doesn't want anyone doing that once she asks for it, then I don't do that. The discussion beforehand is important. Some people are very set on not getting an epidural and some people are really ok with it if they decide they need it.
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So are you asking, when your client asks for an epidural, especially if she was planning on an unmedicated birth, what should your response be?
If so, here are some of my thoughts!
Some women just need to vocalize that labor is hard (and it often is,) and the way that sounds is "I need/want an epidural." Sometimes they want to say it but they don't really mean it. This is why I like having a "code" word (included in the birth plan so EVERYONE knows what it is) and until mom says the code word, we keep trying to move her along.
Ways I have of moving mom along include, "Can you do five more ctx?" "Can you keep going till 4 pm?" "Let's try something different, get in the tub, walk, use the birth ball, (doing something new!)" Let's open the curtains, brush your hair, change your clothes, pep up the music, eat something, etc) and many other support techniques.
I also ask her if she would like more information from an exam, before she makes a final decision. She may say yes or no!
The purpose of the code word isn't to trick Mom, or hope she forgets, I am happy to say, "Mom, you have the code word "zebra" for an epidural, do you want to use it" she will say yes or no!
Some women feel like they don't want/need a code word, and I respect that. They tell me at a prenatal, if I ask, I want it!
I discuss at my prenatals, asking how they would like partner, doula and others to respond when they ask for an epidural.
Another tool that is useful prenatally is Penny Simkin's Pain Medication Preference Scale, which helps me to know how "motivated" (for want of a better word) mom is for a non-medicated birth. Here is a link to the PMPS
And, it is important to realize that women do change their mind in labor, and that long, difficult labors can put a different twist on things.
Is this the information you are looking for, or could you clarify your question so I can take another stab at it.
Sharon
If so, here are some of my thoughts!
Some women just need to vocalize that labor is hard (and it often is,) and the way that sounds is "I need/want an epidural." Sometimes they want to say it but they don't really mean it. This is why I like having a "code" word (included in the birth plan so EVERYONE knows what it is) and until mom says the code word, we keep trying to move her along.
Ways I have of moving mom along include, "Can you do five more ctx?" "Can you keep going till 4 pm?" "Let's try something different, get in the tub, walk, use the birth ball, (doing something new!)" Let's open the curtains, brush your hair, change your clothes, pep up the music, eat something, etc) and many other support techniques.
I also ask her if she would like more information from an exam, before she makes a final decision. She may say yes or no!
The purpose of the code word isn't to trick Mom, or hope she forgets, I am happy to say, "Mom, you have the code word "zebra" for an epidural, do you want to use it" she will say yes or no!
Some women feel like they don't want/need a code word, and I respect that. They tell me at a prenatal, if I ask, I want it!
I discuss at my prenatals, asking how they would like partner, doula and others to respond when they ask for an epidural.
Another tool that is useful prenatally is Penny Simkin's Pain Medication Preference Scale, which helps me to know how "motivated" (for want of a better word) mom is for a non-medicated birth. Here is a link to the PMPS
And, it is important to realize that women do change their mind in labor, and that long, difficult labors can put a different twist on things.
Is this the information you are looking for, or could you clarify your question so I can take another stab at it.
Sharon
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Sorry for the similar post, we must have been typing at the same time! And I am the slower typer!
Sharon
Originally Posted by gemasita  I ask about her Simkin's pain preference number beforehand and we talk about what she would want me to do if she asked for one. If she wants me to try and help her hold off or distract her, I'll do that. If she doesn't want anyone doing that once she asks for it, then I don't do that. The discussion beforehand is important. Some people are very set on not getting an epidural and some people are really ok with it if they decide they need it. |
Sharon
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I like the idea of the code word, I will use that for sure.
a birth I recently attended mom expressed the desire for a natural birth, but didn't want to be out of her mind with pain. She was very focused during labor, so much so that the doctors and nurses didn't know when she was having a contractions even at 6-7 cm and contractions every 2-3 minutes. when suddenly she lost it (for lack of a better word), was begging for "help, I need something". She had mentioned to me earlier that she knew when it got really bad that meant it was almost over and that she hoped she could stick it out without meds when that time came. but when that happened she got the epidural. I asked if she wanted to be checked first and the nurse shot me down "No the doctor just checked her 20 minutes ago, she probably hasn't made any progress, she needs the epidural" during that 20 minutes the nurse had moved the EFM down almost 6 in. it was obvious baby was dropping into the birth canal. so we wait 30 minutes for the anesthesiologist and she gets the epidural. When she is checked immediately after she is complete and baby is out with 1 push. In this case mom was happy with her choice and as long as she is happy I am too. But I know another mom may have been dissapointed that she got the epidural when she was so close to a natural birth.
Anyway I really like the idea of the code word, I think it is important for mom's to be able to voice how intense/painful labor is without being "rescued". I also think it could help with the hospital staff too, I think sometimes they think I am being cruel.
a birth I recently attended mom expressed the desire for a natural birth, but didn't want to be out of her mind with pain. She was very focused during labor, so much so that the doctors and nurses didn't know when she was having a contractions even at 6-7 cm and contractions every 2-3 minutes. when suddenly she lost it (for lack of a better word), was begging for "help, I need something". She had mentioned to me earlier that she knew when it got really bad that meant it was almost over and that she hoped she could stick it out without meds when that time came. but when that happened she got the epidural. I asked if she wanted to be checked first and the nurse shot me down "No the doctor just checked her 20 minutes ago, she probably hasn't made any progress, she needs the epidural" during that 20 minutes the nurse had moved the EFM down almost 6 in. it was obvious baby was dropping into the birth canal. so we wait 30 minutes for the anesthesiologist and she gets the epidural. When she is checked immediately after she is complete and baby is out with 1 push. In this case mom was happy with her choice and as long as she is happy I am too. But I know another mom may have been dissapointed that she got the epidural when she was so close to a natural birth.
Anyway I really like the idea of the code word, I think it is important for mom's to be able to voice how intense/painful labor is without being "rescued". I also think it could help with the hospital staff too, I think sometimes they think I am being cruel.
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I've been at births where the exact thing happened. I don't think it's ever our place to second guess the mom (though like you, I second guess myself). I'd just say "You ARE already doing fantastic. You are handing this. You asked for the epidural, do you want to try one more contraction in X position, or do you want me to get the nurse now?"
Originally Posted by txgal I like the idea of the code word, I will use that for sure. a birth I recently attended mom expressed the desire for a natural birth, but didn't want to be out of her mind with pain. She was very focused during labor, so much so that the doctors and nurses didn't know when she was having a contractions even at 6-7 cm and contractions every 2-3 minutes. when suddenly she lost it (for lack of a better word), was begging for "help, I need something". She had mentioned to me earlier that she knew when it got really bad that meant it was almost over and that she hoped she could stick it out without meds when that time came. but when that happened she got the epidural. I asked if she wanted to be checked first and the nurse shot me down "No the doctor just checked her 20 minutes ago, she probably hasn't made any progress, she needs the epidural" during that 20 minutes the nurse had moved the EFM down almost 6 in. it was obvious baby was dropping into the birth canal. so we wait 30 minutes for the anesthesiologist and she gets the epidural. When she is checked immediately after she is complete and baby is out with 1 push. In this case mom was happy with her choice and as long as she is happy I am too. But I know another mom may have been dissapointed that she got the epidural when she was so close to a natural birth. Anyway I really like the idea of the code word, I think it is important for mom's to be able to voice how intense/painful labor is without being "rescued". I also think it could help with the hospital staff too, I think sometimes they think I am being cruel. |
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..and this is where we help mom (and her partner) to find her/their voice! "Client, do you feel like an exam will help you make a final decision?", and if client says yes, then we facilitate that happening...but this needs to be directed by the client to have any impact!
I would like to think that the nurse does not make the final decision on this, and the client's wishes for more info would be respected. So much of what we do is helping everyone find their way!
Sharon
Originally Posted by txgal I asked if she wanted to be checked first and the nurse shot me down "No the doctor just checked her 20 minutes ago, she probably hasn't made any progress, she needs the epidural" |
I would like to think that the nurse does not make the final decision on this, and the client's wishes for more info would be respected. So much of what we do is helping everyone find their way!
Sharon
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this is exactly what I do too!
Originally Posted by SalmonBayDoula So are you asking, when your client asks for an epidural, especially if she was planning on an unmedicated birth, what should your response be? If so, here are some of my thoughts! Some women just need to vocalize that labor is hard (and it often is,) and the way that sounds is "I need/want an epidural." Sometimes they want to say it but they don't really mean it. This is why I like having a "code" word (included in the birth plan so EVERYONE knows what it is) and until mom says the code word, we keep trying to move her along. Ways I have of moving mom along include, "Can you do five more ctx?" "Can you keep going till 4 pm?" "Let's try something different, get in the tub, walk, use the birth ball, (doing something new!)" Let's open the curtains, brush your hair, change your clothes, pep up the music, eat something, etc) and many other support techniques. I also ask her if she would like more information from an exam, before she makes a final decision. She may say yes or no! The purpose of the code word isn't to trick Mom, or hope she forgets, I am happy to say, "Mom, you have the code word "zebra" for an epidural, do you want to use it" she will say yes or no! Some women feel like they don't want/need a code word, and I respect that. They tell me at a prenatal, if I ask, I want it! I discuss at my prenatals, asking how they would like partner, doula and others to respond when they ask for an epidural. Another tool that is useful prenatally is Penny Simkin's Pain Medication Preference Scale, which helps me to know how "motivated" (for want of a better word) mom is for a non-medicated birth. Here is a link to the PMPS And, it is important to realize that women do change their mind in labor, and that long, difficult labors can put a different twist on things. Is this the information you are looking for, or could you clarify your question so I can take another stab at it. Sharon |
this is exactly what I do too!
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I think the keys is, what an above poster said, there is a time to "give in" on the epidural, but more about making sure you know mom has worked as hard as she could so that SHE will feel good about her choice afterwords, and know she warriored on as long as she could. Then be supportive once its in place. I find if they seem to have doubts during the labor,when they feel no pain, we talk about how she made the best choice for herself and her labor, and try to support her and talk about the pros of an epidrual, since she most likely knows the cons already when she thought she didn't want one.
Its not our place to get pushing or give a mother permission to get one, although i know many times the clients talk to me, as though they are asking for permission, but its really their way or working it out in their minds and just getting my feedback. There are many tricks, as other mentioned, to try buying time, changing the environment up, lights on if they were off, change positions, or locations in the room when possible etc, to get mom re focused a bit, but many women still choose the epi, and its just that, there choice.
I often ask them to try and talk to me about the pain, and why they feel they can't go on, I'm sometimes surprised be the responses I get, and sometimes you can get the mom a little further by working through some of those thoughts and fear.
Its not our place to get pushing or give a mother permission to get one, although i know many times the clients talk to me, as though they are asking for permission, but its really their way or working it out in their minds and just getting my feedback. There are many tricks, as other mentioned, to try buying time, changing the environment up, lights on if they were off, change positions, or locations in the room when possible etc, to get mom re focused a bit, but many women still choose the epi, and its just that, there choice.
I often ask them to try and talk to me about the pain, and why they feel they can't go on, I'm sometimes surprised be the responses I get, and sometimes you can get the mom a little further by working through some of those thoughts and fear.
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I am not a doula, but I wanted to mention a recent experience. We had a client recently that was becoming pre-eclamptic, so we took her to the hospital to be induced. Her prior history was that after her water broke around 4 cm she jumped to 10 within an hour. Well this time it was 20 minutes from water breaking to birth as a result things were very intense. She started begging for anything. My best tactic was to kind of get close to her face. I reminded her of her history. I told her that she was doing great and was probably just in transition. I also told her that she would probably have the baby before the anestesiologist (sp?) got there. And similar such things for maybe 5 -10 minutes. She would partially listen and then tell her husband to get the nurse. Since she was not telling me to stop or get the nurse, I focused on positive affirmation. Her husband hearing what I was saying completely ignored her requests, although if he felt compelled to get the nurse I wouldn't have tried to stop him or anything. All of sudden she changed to, "The baby is coming now." At that point, her friend got the nurse and I got out of the way.
Many times when they say something like that at home, we just tell them that they are doing it. The baby will be there soon. Sometimes reminding them that the baby will probably be born before we get to the hospital works. One client is deathly afraid of needles. I just reminded her how big the epidural needle is and that stopped her. This may not always work, but is something to try.
Many times when they say something like that at home, we just tell them that they are doing it. The baby will be there soon. Sometimes reminding them that the baby will probably be born before we get to the hospital works. One client is deathly afraid of needles. I just reminded her how big the epidural needle is and that stopped her. This may not always work, but is something to try.
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I used to feel that any mom would feel disappointed for being "that close" to a natural birth and then not getting it. Then I realized that that might be how *I* would feel but not every client is like me. Now, I pay very close attention to our discussions beforehand so that I know which clients this goal is important to. I find that most of the time, if the client had the goal of going natural and also explained that this is REALLY important to her, then when we talk about getting checked first or holding out for a few more contractions, she is very receptive. If going natural wasn't a huge priority, then she is often not as receptive and this is because what is most important to them at that moment is getting the pain relief that they are asking for. So if we don't get a check in, that's really ok for that situation. So once I sort of "let go" of how I think *I* might feel, my job became much easier!
SalmonBayDoula - no problem, BTW. What a great response you posted!
| In this case mom was happy with her choice and as long as she is happy I am too. But I know another mom may have been dissapointed that she got the epidural when she was so close to a natural birth. |
SalmonBayDoula - no problem, BTW. What a great response you posted!
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I would never call it 'giving-in'. We are not the epidural masters weilding the drugs, choosing who is hurting badly enough to diserve them.
However it is the case that a lot of women in labour will say they want an epidural to voice their pain, even when the dont.
So what I think you are asking how to destinguish when we should try and help the woman pull it together and work through the pain, or call the nurse to order the anaesthesia...
In a case that you described, where a woman was coping well and suddenly "lost it" and was yelling for an epidural, I would take this as a sign that something is happening, the baby is descending and labour is progressing. I would assure her that it is a really good sign and work to get her together and back into a rhythm where she can cope with contractions. If her pain suddenly increases substancially because of perhaps a change in position of the baby or something, it can take a few contractions to be able to adjust and cope, and sometimes women need to lose it for a little bit. In this case I would not run for the epidural but would work towards calming her down and getting into the groove again, probably with a shower or in a tub, and let her decide then if she is still interested.
If a woman is yelling out for an epidural during a contraction to tell you just how badly it f*ing hurts, she is probably just expressing herself. If she is between contractions and she looks at you seriously and says she wants an epidural, she wants an epidural. Always take her seriously when she says that. Generally I ask her to go through 5 more contractions, and if she brings it up after that we discuss it again, but often by then we get something that works going and she forgets.
It all comes down to a judgement call. Be compassionate, and never seek to deprive a woman who is suffering from the medication she is entitled to.
However it is the case that a lot of women in labour will say they want an epidural to voice their pain, even when the dont.
So what I think you are asking how to destinguish when we should try and help the woman pull it together and work through the pain, or call the nurse to order the anaesthesia...
In a case that you described, where a woman was coping well and suddenly "lost it" and was yelling for an epidural, I would take this as a sign that something is happening, the baby is descending and labour is progressing. I would assure her that it is a really good sign and work to get her together and back into a rhythm where she can cope with contractions. If her pain suddenly increases substancially because of perhaps a change in position of the baby or something, it can take a few contractions to be able to adjust and cope, and sometimes women need to lose it for a little bit. In this case I would not run for the epidural but would work towards calming her down and getting into the groove again, probably with a shower or in a tub, and let her decide then if she is still interested.
If a woman is yelling out for an epidural during a contraction to tell you just how badly it f*ing hurts, she is probably just expressing herself. If she is between contractions and she looks at you seriously and says she wants an epidural, she wants an epidural. Always take her seriously when she says that. Generally I ask her to go through 5 more contractions, and if she brings it up after that we discuss it again, but often by then we get something that works going and she forgets.
It all comes down to a judgement call. Be compassionate, and never seek to deprive a woman who is suffering from the medication she is entitled to.
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To add to Salmon Bay's ideas, I very much discuss coping vs suffering (another Simkin tenent) in our prenatals.
When I have a client who is starting to express a desire for drugs when she was planning an unmedicated birth I ask her between contractions how she feels she's "coping" and often find that she's doing well in her own head.
If she's suffering, we call the Nurse and discuss pain med options if she indicates that's her wish.
When I have a client who is starting to express a desire for drugs when she was planning an unmedicated birth I ask her between contractions how she feels she's "coping" and often find that she's doing well in her own head.
If she's suffering, we call the Nurse and discuss pain med options if she indicates that's her wish.
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The woman who trained me from Alace talked about the fact that generally you can tell the difference between a woman who is complaining about the fact that that part of labor really stinks ("I hate this. I want an epidural.") and the woman who WANTS. THE. EPIDURAL. Generally, she said, you will tell the difference because the woman will take you by the cheeks and shake you, while saying very calmly, "I. WILL. TAKE. THE. EPIDURAL. N-O-W."
Now, that isn't necessarily excactly how it happens, but is generally quite close in my experience. Of all the births I have doula'd, I have had three women get the epidural. The difference with ALL of them being a prolonged first stage, exhaustion, and frustration at lack of progress. All three of them looked me very calmly in the eyes and said that it was time for the drugs.
The last one was actually just a couple of months ago. Because she is also my friend and because she was a VBAC and had told me VERY firmly that under NO circumstances was she going to get the epidural when we had prenatal discussions, I helped her through a few more contractions, I changed things up, put her in the shower with some aroma-therapy and the lights off, and talked to her husband.
THe difference between her and the other two was that the other two just looked at us, told us they wanted the epidural, and then hit the call button to get the nurse. With this last one, she was begging US to get the nurse (us being me and her husband). When I put her in ths shower, I had, as I said, a chat with her husband. I said that he needed to talk to her very frankly about the fact that he was NOT going to be the one to give her permission, or to call the nurse, because in twenty years, did he want to be the one whose fault it was? Did she want to "blame" him for "giving in?" THis didn't mean that she couldn't get the epidural, but that she was the one who had to make the decision to get it, that we could not take that responsibility. I talk very thoroughly with my clients about the pros and cons of epidurals. I believe strongly that for some women it is very VERY beneficial, and can be the difference between a vaginal birth and not...but they also know the drawbacks and dangers before they go in to birth, so I know and they know that they are making an informed choice, not a fly by night decision. So, she and her husband talked, she THANKED him for giving her that talk, and that responsibility, and hugged him, and hit the call button. And I DO believe in her case that it was the difference between a VBAC and a repeat cesarean.
So...I have used that a couple times quite effectively. If the woman wants an epidural it is not the place of the doula to stop her. But it is the place of the doula to help that woman determine whether it is REALLY that she wants it, or that she is just voicing her discomfort. Most of the time, I will say something like, "I know. This is REALLY hard work, but every contraction is getting you a little closer to holding that baby in your arms." If she continues to ask for help outside of her support system, I will suggest a change of scene, position, etc. Generally it is nearing time for transition, so if we have a tub available, I will put her in the tub, if we don't the shower is usually where we head. If she is still saying that she can't do it and asking for the nurse for an epidural, I will say, "Sweetie, the call button is right here," and hand it to her. 99% of the time, she will put it down and keep talking.
And that leads to something my preceptor says: When they're at home, they want to go to the hospital when they're in transition. When they are at the hospital they either want to go home or get the epidural...they just want to have an experience other than that which they are currently having!
I generally talk to women about that, too, in prenatals. Many have told me later that they kept that in their head and it kept them from asking for an epidural at all, because it helped them realize that they were in or near transition. *shrug*
Now, that isn't necessarily excactly how it happens, but is generally quite close in my experience. Of all the births I have doula'd, I have had three women get the epidural. The difference with ALL of them being a prolonged first stage, exhaustion, and frustration at lack of progress. All three of them looked me very calmly in the eyes and said that it was time for the drugs.
The last one was actually just a couple of months ago. Because she is also my friend and because she was a VBAC and had told me VERY firmly that under NO circumstances was she going to get the epidural when we had prenatal discussions, I helped her through a few more contractions, I changed things up, put her in the shower with some aroma-therapy and the lights off, and talked to her husband.
THe difference between her and the other two was that the other two just looked at us, told us they wanted the epidural, and then hit the call button to get the nurse. With this last one, she was begging US to get the nurse (us being me and her husband). When I put her in ths shower, I had, as I said, a chat with her husband. I said that he needed to talk to her very frankly about the fact that he was NOT going to be the one to give her permission, or to call the nurse, because in twenty years, did he want to be the one whose fault it was? Did she want to "blame" him for "giving in?" THis didn't mean that she couldn't get the epidural, but that she was the one who had to make the decision to get it, that we could not take that responsibility. I talk very thoroughly with my clients about the pros and cons of epidurals. I believe strongly that for some women it is very VERY beneficial, and can be the difference between a vaginal birth and not...but they also know the drawbacks and dangers before they go in to birth, so I know and they know that they are making an informed choice, not a fly by night decision. So, she and her husband talked, she THANKED him for giving her that talk, and that responsibility, and hugged him, and hit the call button. And I DO believe in her case that it was the difference between a VBAC and a repeat cesarean.
So...I have used that a couple times quite effectively. If the woman wants an epidural it is not the place of the doula to stop her. But it is the place of the doula to help that woman determine whether it is REALLY that she wants it, or that she is just voicing her discomfort. Most of the time, I will say something like, "I know. This is REALLY hard work, but every contraction is getting you a little closer to holding that baby in your arms." If she continues to ask for help outside of her support system, I will suggest a change of scene, position, etc. Generally it is nearing time for transition, so if we have a tub available, I will put her in the tub, if we don't the shower is usually where we head. If she is still saying that she can't do it and asking for the nurse for an epidural, I will say, "Sweetie, the call button is right here," and hand it to her. 99% of the time, she will put it down and keep talking.
And that leads to something my preceptor says: When they're at home, they want to go to the hospital when they're in transition. When they are at the hospital they either want to go home or get the epidural...they just want to have an experience other than that which they are currently having!
I generally talk to women about that, too, in prenatals. Many have told me later that they kept that in their head and it kept them from asking for an epidural at all, because it helped them realize that they were in or near transition. *shrug*
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I haven't read everything, but I know of a couple of doulas who tell their clients, "I totally understand that sometimes moms say they need drugs and really that's just now they cope. However, I'm not going to talk you out of it over and over again. If you tell me you want a natural labor, then say you want an epidural, I'll talk you out of it/help you put it off THREE TIMES."
After three times, if mom says she wants the epidural, then the answer is "that's the fourth time you've said you want the epidural. If you really want it, I'll go let the nurse know." Before that, she might say "you're doing a great job, why not work like this for another 30 minutes?" or "you really wanted a natural birth, remember all of the reasons you told me you wanted to avoid the drugs?"
Of course, this only applies to clients who expressed a desire to have a natural birth and not to clients who have been planning for an epidural all along.
After three times, if mom says she wants the epidural, then the answer is "that's the fourth time you've said you want the epidural. If you really want it, I'll go let the nurse know." Before that, she might say "you're doing a great job, why not work like this for another 30 minutes?" or "you really wanted a natural birth, remember all of the reasons you told me you wanted to avoid the drugs?"
Of course, this only applies to clients who expressed a desire to have a natural birth and not to clients who have been planning for an epidural all along.
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Charmie! It's so good to see you on! I haven't seen you around in a while.
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Yeah, it's funny how babies cut down on your posting time, isn't it?
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My suggestion ties in with what a couple of previous posters have said. Look at the circumstances surrounding the request. I was induced early with my last baby and my doula was out of town, so I was with my dh and my sister. After a verrrry long early labor, I hit active labor and started yelling because it had gotten very intense very quickly. I had only only wanted to be checked at my request and I wanted them to tell my dh first and for him to tell me only if it was going to help me. But they checked me and I was 4 cm and told them desperately that if I was going to do this much longer I needed an epidural.
My request for an epidural was brought on by the discouraging news from the vaginal exam. It was freaking intense before that, but it wasn't unbearable. Having it quantified really messed me up. If your client is coping fine and has a discouraging VE and then requests an epidural, perhaps it isn't about the epidural, but the fact that she is "doing the math" (if it took x amount of time to get to y cm then it is going to take a amount of time to be complete) and you can reassure her accordingly.
My request for an epidural was brought on by the discouraging news from the vaginal exam. It was freaking intense before that, but it wasn't unbearable. Having it quantified really messed me up. If your client is coping fine and has a discouraging VE and then requests an epidural, perhaps it isn't about the epidural, but the fact that she is "doing the math" (if it took x amount of time to get to y cm then it is going to take a amount of time to be complete) and you can reassure her accordingly.
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Re: Discouraging vaginal exams.
When mom has an exam I always ask the nurse while she's doing the exam what the station and effacement is.
I find that by getting those details we have a larger view of overall progress.
So if mom was 2CM/50% and babe was -3
the next exam shows
2CM/80% and babe at -1 then she HAS made progress. We talk about baby moving down and putting more pressure on the cervix and how the cervix can dilate more quickly later down the road and it needs to thin out completely to dilate fully.
Usually pointing out the other progress coupled with teaching clients the 6 ways to progress in labor does the trick of finding gold in otherwise discouraging vaginal exams.
When mom has an exam I always ask the nurse while she's doing the exam what the station and effacement is.
I find that by getting those details we have a larger view of overall progress.
So if mom was 2CM/50% and babe was -3
the next exam shows
2CM/80% and babe at -1 then she HAS made progress. We talk about baby moving down and putting more pressure on the cervix and how the cervix can dilate more quickly later down the road and it needs to thin out completely to dilate fully.
Usually pointing out the other progress coupled with teaching clients the 6 ways to progress in labor does the trick of finding gold in otherwise discouraging vaginal exams.
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