A Dozen Days of Doula Scoop: Day 4

I think I want an epidural. Do I still need a doula?

Before we delve into the specifics of doulas at epidural births, I have to spend a little time talking about epidurals. I had an unplanned epidural with my first birth (meaning I wanted to do it without medication, but called for the drugs after the pain escalated and I was completely demoralized by my lack of progress, see this post), and I had my second baby without any pain relief (not even a Tylenol!), so I have personally experienced the gamut of pain relief options. I certainly do not condemn any mom who chooses the drugs; after all, the process of childbirth is for many people the peak pain level they will experience in their life. However, I think we are often woefully uninformed about the potential drawbacks and side effects of epidurals.

Did you know? (Statistics taken from Hey! Who's Having this Baby Anyway?)

• Epidurals cause a drop in blood pressure in 30 to 35 percent of moms. Drops in blood pressure can lead to a fetal distress as the mom's blood doesn't pump vigorously enough to oxygenate the baby's blood. This can directly lead to the mom having a cesarean birth if her blood pressure cannot be stabilized by the use of additional medications.
• Epidurals cause fever in the mom in about 15 percent of moms when the epidural is in place more than 4 hours. Why is this a problem? Doctors and nurses have no way of knowing which fevers are caused by the epidural, and which may be the result of infection. Therefore, moms are often separated from their babies as their babies are checked for infection. Some babies may even have to have a spinal tap or be treated with antibiotics in the hospital for several days.
• 10 percent of the time, epidurals offer only partial or nonexistent pain relief. If this occurs, the epidural may have to be reinserted for better placement to provide more complete pain relief.
• Spinal headache occurs in 1 to 10 percent of epidural moms. I've had one of these. They are NOT FUN! The only way to keep the headache from pounding out of control is to lay flat on your back. Not what you want to be doing with a newborn to care for. These headaches can last a few days or even a few weeks.
• Several other side effects occur often with epidurals: postpartum bladder dysfunction, uncontrollable shivering, itching of the face, neck, and throat, nausea and vomiting, postpartum backache, and inability to move about freely on your own (in 100% of epidural moms).
• Some rare, but very serious, risks of epidurals also exist: convulsions, respiratory paralysis, cardiac arrest, allergic shock, nerve injury and maternal death.

It's enough to make you consider a natural birth, isn't it? However, if you decide that there is no way you can live through the birth process without pain relief, there are some ways to minimize the risks of the most common epidural problems. The number one way to minimize your risk is to have the epidural placed as late in labor as possible (No, not when you're pushing the baby out...). Postponing the epidural means you can keep moving longer, keep cool longer (no epidural-related fevers), and maybe just summit that labor pain mountain and push your baby out sans any medicine at all. It does mean that you have to cope with labor pain longer! That's where your doula can keep you going. When you don't think you can do it, she's there to say, "Let's just do this next contraction." Should you decide you need the epidural, the doula is there to provide emotional support. After all, even though you may not be feeling the pain, you are still birthing your baby! Doulas also make sure you keep moving. Even if you are completely numb, you can still roll from side to side (with help). This is often enough to keep the baby from getting stuck in a bad position. Your doula can also remind you to request some time to labor down once you are fully dilated. Because epidural moms have loss of sensation, it's often very difficult for them to push their babies out. It's harder to focus your pushing efforts when you can't feel what you're pushing (I marvel that epidural moms can push at all!). Often, doctors end up pulling babies out with vacuum extractors because moms can't get their babies out. The best way to prevent some of these problems is to wait! Once you are fully dilated, laboring down means doing nothing for a while, either until you feel pressure, or until the baby's head is visible. Unfortunately, in most hospitals, the minute you're fully dilated, everyone is yelling at you to push and counting to ten. You almost always have to ask for some time to labor down.

So, while it may be easier to get through an epidural birth without a doula than an unmedicated birth, an epidural is not a replacement for a doula! Will an epidural be sensitive to your emotional needs in labor? I don't think so! Do you need PIES during an epidural birth? Yes!