Four and a half years ago I attended a birth that affirmed, to me, why mothers who CHOOSE epidurals should still consider hiring a doula. Mama was 42 weeks and consented to an induction for being "overdue." She was hoping to still go pain medication free. I supported her and her husband as she worked hard for several hours before reaching a breaking point emotionally and asking for an epidural. When her epidural was placed, it only worked on one side of her body. She felt the full force of the contractions on the other side. So we rolled her to help distribute the medication on the other side.. While this helped shift coverage of the epidural medication to the other side as well, it still left an area on her abdomen that was feeling the force of the contractions. It was about the size of my hand. I sat pressing on this spot through contractions for several hours before mom was complete. Once her epidural was placed we also needed to do some positional tricks to help make room in her pelvis for a baby descending with his head just a little crooked. When it came time to push we thought for sure this would go quickly, we could see the baby descending. Unfortunately the mother pushed for a grueling 4.5 hours due to that crooked head. She and her family needed all the love and support that the midwives and I had to give. We worked hard to overcome the epidural in order to move her to alternative positions for pushing to help this baby descend. He was born vaginally but mom needed a lot of support for that birth.
To begin with, your doula will help you to make an informed decision about receiving an epidural by encouraging you to ask questions and to help you review the pros and cons. She can also help you with comfort measures until you are further along in your labor before receiving your epidural which will help to decrease the number of additional interventions such as pitocin augmentation, episiotomy, forceps delivery, and cesarean. Once you are in an established labor pattern it is less likely you will have trouble with baby's presentation as your labor continues. and baby's position is a major factor in stalled labors. It is important to have an open mind about the tools and tricks you will use to navigate your birthing journey, you may find that you do not need that epidural after all. Your doula will support you, no matter what you choose.
Having an epidural placed is no cakewalk either! Often it can be arranged that your doula can stay with you and your partner while the anesthesiologist places your epidural. She can support you through the one or two contractions you will have during placement, as well as helping you to cope with the general discomfort of having it placed. Afterwards she can help to get you and your family comfortable.
Because your doula is amazing, she will ensure that you remain the focus of your birthing journey after your epidural is placed. There are many tubes and monitors involved when an epidural is in place, so that a mother's assigned care providers can monitor her labor from down the hall. Your doula continues to focus on you and not the equipment you are surrounded by, She encourages the rest of your support team to stay supportive and engaged in the process.
Your doula will help you change position regularly to encourage baby to descend. She may use pillows or a specialized birth ball to get you comfortable and keep your labor progressing. When it comes time to push your doula can work with your partner and other support people to get into more effective positions for pushing your baby out. She may spot you at the squat bar, or help you with a rebozo to maximize your efforts. Pushing a baby out when you have an epidural often can take a little longer, and your doula will be there to encourage you and your supporters during this time..
Overall your doula is still caring for your emotional well-being. If an emergency arises she will provide comfort and information as the medical staff goes into swift action. She remains in YOUR service at all times and works to meet your needs and the needs of your family. "Drs & Midwives are focused on 'healthy baby, healthy mom.' Doulas are focused on 'healthy mind, healthy bond." (Randy Patterson, Owner & Operator of Pro Doula). This means your doula is going to continue to actively serve you regardless of what type of birth you choose or what happens during your labor and birth.
Epidurals can be an amazing tool for some mothers, there is definitely a time and a place and I have seen an epidural save a woman from a c-section by allowing her to rest and relax, and allowing baby to navigate the pelvis. I have seen an epidural bring down a climbing blood pressure to protect a mother and baby and allow a non-emergent birth. I have also seen epidurals fail to provide relief. I have seen them paralyze a woman's pelvic floor and lead to vacuum assisted deliveries and cesarean sections I have seen epidurals cause baby and mom to suddenly go into distress and get rushed into c/s. I have seen them provide spotty relief. I have seen them leave women alone in a room and ignored by her family since now she is not in pain. I have also served women who planned an epidural but were unable to get one due to a rapid labor or a long wait for the anesthesiologist. All these reasons are why you need a doula there, even if you PLAN on getting an epidural.