DOULAS AND EPIDURALS
"I am planning on having an epidural so I don't need to hire a doula." Many doulas have heard this comment before. Hiring a doula doesn't automatically mean that you cannot have an epidural (or that you won't want one!). The following article explains the role a doula takes for a client that has chosen to use epidural anaesthesia for their baby's birth.
Doulas and Epidurals by Kelli Way, ICCE, CD(DONA)
Your doula’s role is to assist you during birth. With or without pain medications, you are giving birth, and your doula will be there to comfort and support you.
Giving birth to your baby is much more than a medical procedure. It is an emotional as well as a physical journey, and having a doula with you can help smooth the crucial transition from pregnancy into parenthood. Both parents will benefit from the nurturing care a doula provides.
Epidurals do not usually take all the pain away. You will still be required to use some other forms of comfort measures at times.
Although good to excellent pain relief is obtained in 90% of epidurals, few epidurals take away all the pain. Some hospitals advertise "painless childbirth," but few women experience it that way. There are several reasons why an expectation of "painless childbirth" may be unrealistic. Often you must wait for the anaesthesiologist to become available. You may need to wait while you receive 1-2 liters of i.v. fluid. The procedure itself can take up to 30 minutes, and you may not have complete pain relief for another 20 minutes. Once you are close to complete dilation, the epidural may need to wear off, or you may experience breakthrough pain. Rarely, the epidural gives only patchy pain relief, or doesn’t give pain relief at all.
If you experience any of these situations, or if you prefer to avoid using the epidural until you are 5cm to reduce your chances of needing a Cesarean, your doula will be invaluable in helping you use breathing and relaxation techniques, suggesting position changes, and using non-medical forms of comfort measures.
Epidurals often (over 70%) come with mild side effects, which are unpleasant although not medically serious, such as itching, nausea, and shaking. Your doula will stay at your side, helping you cope with any side effects you have, and giving you information about your options.
While an epidural relieves most of the physical pain, it does not affect your need for reassurance.
You might expect that with pain relief, all your worries will go away. Interestingly, this does not seem to happen. Women experience the same emotions during labour whether they use epidurals or not. Many times, the medical staff feel that if a woman has pain relief, she doesn’t need the same type of gentle emotional support. Women often feel even more frightened and worried when they sense this emotional withdrawal. Your doula will continue to focus on what you are feeling, and will give you the reassurance and comfort you need.
Help in coping with pain is only one small part of your doula’s role.
Epidurals do not hold your hand, rub your shoulders, explain what is happening or help you make decisions. Epidurals do not get you ice chips or remind you to urinate. Epidurals cannot suggest position changes to help labour progress. Epidurals will never advocate for you or help you get what you need from the hospital staff.
Epidural or doula?
You may want both. If you are considering using an epidural for pain relief, make sure that you choose a doula who will support that decision. Talking about your options and feelings in advance will make your labour much smoother, leaving you free to concentrate on the birth of your baby.