When your client gets an epidural...

[Luv2bemommy]

What do you do? Do you try and talk her out of it? Telling her she is doing great, etc or do you just let her make that choice? Once she gets the epidural what do you do? How would you help the mother since she isnt in anymore pain??

I have no idea what to do if this happens, I never had an epidural myself but they don't feel any pain right? Is this something I should try to let them avoid if all possible?

[fearlessbirth]

If you have 'The Doula Book' or can get your hands on it, they talk about this exactly. I wondered that myself but am reading it for my cert and found it very helpful. If you can't find it, or don't have it, I can 'paraphrase' for you what they say when I have the book on me.

Good Luck!

Or, maybe you could google 'doulas and epidurals' and see what you find.

[Tiffany]

A lot of times epidurals do NOT work perfectly. Mom may still feel pressure on her hips, or back. The last epidural mom I supported needed me to constantly press on her hip while she laid on her side. It was hard work!

If the epidural works well and it's been a long day/night, you can try and catch some rest especially if that is what mom is doing. I will usually finish up some paper work or write out what has happened so far so I don't forget. Things start moving again when mom is fully dilated and it's time to push. Sometimes she needs a lot of help. I always talk with mom about asking to have the epdiral turned down so it can help her feel the urge to push.

As for talking clients out of epidurals--I don't do that unless they have specifically asked me to during a prenatal visit. Sometimes a mom will tell me she wants to go naturally and if she starts asking for an epidural during labor, that she wants me to help her put if off. I'll tell her "let's get through this contraction and we'll talk about it" and you see how many contractions she'll let you say that through.

[Luv2bemommy]

Quote:

Originally Posted by fearlessbirth If you have 'The Doula Book' or can get your hands on it, they talk about this exactly. I wondered that myself but am reading it for my cert and found it very helpful. If you can't find it, or don't have it, I can 'paraphrase' for you what they say when I have the book on me. Good Luck! Or, maybe you could google 'doulas and epidurals' and see what you find.

I am reading the doula book now, I am almost at the end though but I dont remember anything about epidurals?? What pages is it on?

Reason I am asking is my friend that agreed to let me be her doula, is basically clueless about childbirth.. I am trying to get her to attend the CB classes with me to get her some more info.. I want to print out some things to take to her also.. I havent got to talk to her about what she wants for her birth though but you know how sometimes you know someone and can tell they would want pain meds?? I hope she proves me wrong but it just seems like she will surrender real fast.. I want to tell her all I know about the risks of epidurals but I dont want to scare her to death since it's her first baby.

[Tiffany]

Make up an epidural pro and con sheet, and just be honest about it. I have one that was given to me at a training and I make copies and give it to all of my clients. Most of the time they find out something they did not know about it and it seems to turn them off!

[fearlessbirth]

Candice...It's on page 57. I was glad it's in there cause I was clueless and felt like I wouldn't be needed should I ever be in that situation.

[MothertheMother]

www.bestdoulas.com has an epidural contract you can use with your clients. I am pretty sure they say on the site that you can use their handouts as long as you don't change it and leave their name on it. I don't think I will use it because it is a little scary but it definitely covers all of the possible risks of an epidural. I wouldn't ask a client to sign it but I would definitly go over it. Maybe put in the "book" of handouts? It also has a list of options if the client asks for an epidural...


If I ask for an epidural, I want my doula to:

Talk me out of it, no matter what I say.
Remind me that I really don't want it, unless I use the release word _________.
Ask me to try ______ more contractions and then, if I still want it, I will ask again.
Remind me that I want to try to wait until my cervix is ______ cm dilated.
Help me get the epidural when my cervix is ______ cm dilated.
Help me get the epidural as soon as I ask for it.
from www.bestdoulas.com

There are some side effects of an epidural that mom could use some help through. One is shaking. If you help her relax she wont shake as much. If her blood pressure drops (which is common) they will give her a shot to boost it back up. A common side effect from that is vomiting. Nobody likes to do that. Sometimes the epidural is only effective on one side or it is spotty. In that case you will have a lot of work to do. She will definitely need help trying to cope since she will still feel pain but wont be able to change positions to help with the pain. If she didn't wan't any medication before labor started and ended up getting an epidural for whatever reason she may need a ton of encouragment that she didn't "fail."

from "The Doula Advantage" by Rachel Gurevich

"Medication is not a substitute for support, " explains Devorah Shulman, a doula from New York. "Even though the pain is no longer something they have to deal with to the same extent, there is still fear. Women still need reassurance. They still need their ice chips. They still get hot and sweaty. They still might need massage. In many medicated births, the senstation of pain increases as the baby descends through the pelvis and second stage approaches. Someone who's not expecting to feel any pain whatsoever needs support."
On the other hand, your epidural may work too well. During the pushing stages, being able to feel the baby and work with the contractionsis practically impossible when you're numb from the waiste down. Some doctors will "turn the epidural down" so you can feel just enough to push effectively, but from personal experience, I can tell you this really does not help. Your doula can coach you on how and when to push. She will also support you in whatever position you're pushing in."

I have mixed emotions about this book. The way it is laid out made it hard for me to read. In addition to the regular text of the book there were a ton of stories (some just blurbs) from parents about their experience with the particular subject at hand. You have to stop halfway through to read to extra stuff and it just kind of bugs me to do that. On the other hand it is full of wonderful information. Very quick read, once you get past the side notes.

could this be any longer????

[tlcdoula]

What do you do? When I am working with a mother it really depends on the situation. If I have worked with this mother as a private client then we would have discussed this extensively. We would have talked about the pros and cons of the situation, and I would have also had her create a word that was a signal to me that she really wanted the epidural. Unfortunately many times when moms are going through a hard contraction they might want an epidural and often times the nurse will hope right on that. However with a "secret word" then we both truly know that she is finished and wants the epidural. If it is a client through the hospital typically what I will do is try to speak with her on what her wishes are the second I get to the hospital, so that I know what she is really leaning towards and will probably ask her about a clue word then.

Do you try and talk her out of it? I would NEVER talk a mother out of an epidural because it isn't my birth and isn't my body. Plus I would hate for the mother to blame me later on for not "allowing" her to get an epidural.

Telling her she is doing great, etc or do you just let her make that choice? As far as telling her she is doing great - I think that depends on whether she was or not. I do not lie to a mother, so if she is within the normal range then yes I would tell her that she is doing very well. Now, for the mother who is 2 cms and flipping out - which I had once due to a sexual abuse past I just highlighted what was going positively (i.e. I noticed that contraction as very strong and difficult for you, but I think you really were able to keep your shoulders relaxed during that one).

Once she gets the epidural what do you do? How would you help the mother since she isnt in anymore pain?? It depends on what she is doing. If she is sleeping I sleep. If she isn't then it is her choice on what we do. I will usually talk to her and talk about her baby, because sometimes getting an epidural can really "remove" a mother from the whole experience. I will also sit close while she watches t.v. - I am still there for her in whatever manner she needs me. Just because she has an epidural doesn't mean she doesn't need support. Sometimes these mothers need support even more because they feel no discomfort and the event may not really feel real to them.

[tlcdoula]

Quote:

Originally Posted by Luv2bemommy I am reading the doula book now, I am almost at the end though but I dont remember anything about epidurals?? What pages is it on? Reason I am asking is my friend that agreed to let me be her doula, is basically clueless about childbirth.. I am trying to get her to attend the CB classes with me to get her some more info.. I want to print out some things to take to her also.. I havent got to talk to her about what she wants for her birth though but you know how sometimes you know someone and can tell they would want pain meds?? I hope she proves me wrong but it just seems like she will surrender real fast.. I want to tell her all I know about the risks of epidurals but I dont want to scare her to death since it's her first baby.

Candice - why not plan out prenatals and just explain that as part of your process you really want to "practice" on her before you get a client who is a stranger. My sister was like your friend - no classes, knew she was getting an epidural, etc. I told her that I really, really would appreciate it if she would let me come to her house to go through mock prenatal visits so that when I got a client that I didn't know I would know whether I was doing it good or not. I then asked her to critique my prenatal. I was able to give her information and she thought she was helping me by critiquing my visits

[Luv2bemommy]

GREAT idea! I will do that! She hasnt told me if she wants an epidural or not but she did say she wants to breastfeed.. So I hope to meet with her a few times before the birth, she is already 32 weeks! Also thanks for the website! I will check it out right now!

[Luv2bemommy]

Just wanted to add that website is awesome!! It has tons of print outs with lots of info!!!!!!

[susan1]

I like the handouts on the bestdoulas.com

Thanks,
Susan

[loveslabor]

One of my clients is probably going to have a scheduled induction with an epidural and I was wondering what I would do in this case.

Afte rI had my epi during my labor, I didn't need support from anyone. I just slept. I felt guilty to have my midwives just sitting there watching me.

[dynamicdoula]

I touch on this with my clients prenatally:

* What are your wishes for pain management?
* (For ALL moms, even moms who are going unmedicated)- What are your pain relief preferences if all non-medical options are not working for you?
* (I give a handout about epidurals risks/benefits adapted (with permission) from Tracy at B*E*S*T doulas, you can find it on her site) (Note: I do not use this as a contract because I do not expect my clients to 'answer' to me for any part of their labor/birth - rather i use it as a tool to help them have an opportunity to explore risks/benefits before they are in labor, and as a tool to help us discuss how WE will strategize if she requests pain medication, - that's it. No signatures involved.)
* I explain how sometimes moms will ask for an epidural before they truly want one, just because it is soothing to *ask* for it, or because it symbolizes a measure of time (she knows she can get one at 4, if she can 'have one' now, she knows she's at least 4cm). Bearing that in mind, what strategies can we use so that if you ask for pain relief, I will know you truly want it and don't go running for a nurse before you're ready?

• secret code- pick a word that will signal that she's 'serious'
• ask me to try another contraction before deciding
• try a position change first
• have a vaginal exam first

I also let them know that what they want at the peak of the contraction might not be the same thing they want in between, and that if they are asking for the epidural/medication during the contraction, I will help them get through that moment and let THEM raise the issue again in between. If mom asks me between contractions, I immediately call the nurse for her or tell dad to (or whatever).

If mom is clearly suffering and says she wants medication, I do not hesitate with all the other stuff, I will call the nurse immediately.

We are not in our client's bodies at the time they are making these decisions, and therefore can not POSSIBLY know what she 'needs'.

One thing to think through beyond her getting the epidural is what YOUR job becomes after she has medication.

Very typically after a mom has medication...
*the curtains get opened, lights go on
*tv comes on
*phone starts ringing or getting used
*mom 'comes back' to herself
*support people ease back to couches, chairs
*everyone sleeps
*support people take break outside of the room to eat/make calls/bathroom/etc

Think about what this does to a labor that is underway... we know that during sex, we need quiet, privacy, dim lighting, intimacy.... we wouldn't try to have sex with lights on, TV on, people coming in and out, etc (unless you're in to that ). As the doula, I always communicate with my client after her epidural about keeping the 'labor space' intact. Keep the lights low, rest with your partner in bed with you, touch each other's skin. Keep the phone off, keep the TV off- and I remain in close contact with her, touching her (altho not as much, she isn't in the same need). I talk about how using the pain relief to her benefit for positioning and whatnot is important, so we try MANY different positions in the bed. Hands & knees, knee chest, sitting up as in a giant birth chair. Break down the foot of the bed (ask the nurs eto do it, obviously) and have her hang her knees down while you or her partner sits behind her and supports her. Let everyone sleep if there is the opportunity- you're all working hard and need your rest! After sleep, keep the labor space intact as much as you can. Mom might be more interested in checing in with her family and watching TV- you have to follow her lead, but your input will be meaningful to her, too.

Also, be clear in YOUR intention when you are attending a mom with an epidural: do you feel it is your job to talk her out of it? How do you feel inside when she gets it, disappointed? Frustrated? Angry? Like she's given up? Relieved? Accepting? Open? Trusting of her? Something else? Be honest because the only person you have to answer that question to is yourself- but it is important that your support of her is seamless, no matter what you are feeling.

After a client gets an epidural, I immediately celebrate all the ground she's gained so far, and her wise decision to get some rest before the rest of the hard work she has ahead of her comes. It is GOOD to get rest, she will need it for pushing and when she meets her baby. It also gives dad permission to sleep, too, and he doesn't have the benefit of all the labor hormones to keep him going- he needs to rest, too. Sometimes the couple is reluctant, and I remind them that they are going to be parents today- sleep will be a luxury for a while! Get it while they can. Then I talk to her about the importance of fetal positioning, and how epidurals/laying in bed can affect it, and what we can do about it. I pass on the info and then follow her lead- some moms aren't interested in doing any OFP in the bed, but most moms are open to it. I also take dad/partner aside and talk to them about how the vibe changes in teh room after the epidural and what we can do to keep us in a labor mindset, too.

I encourage you to do some deeper processing about your opinions with pain medication, and medication + doulas, and be open to the experiences that are offered to you- they are for YOU as much as they are the mothers you attend!

[Tiffany]

Great post Kristina!