If she opts for an epidural

Abbydoula · 08-12-2006, 02:23 PM

Hi all,

It's been a while since I posted here. My first interview went well enough to land me first clients (yay!). I'm officially "on call" now, and a bit nervous about child care arrangements...but I've done what I can, and now I wait.

My client feels very strongly about using an epidural...in that she WANTS one if it hurts too much...which means she likely will. She's very scared of pain, and blah blah blah.

What can I DO for her if she has one? I feel like all my skills are around coping with pain and positioning...if she has an epidural, what do YOU do?

Thanks,

Abby

birthhands · 08-12-2006, 02:31 PM

There are still quite a few things that you can do for a mama who has had an epidural - she will still need a cool cloth for her face and perhaps a little hand held fan to keep her cool. She will need you to continue to provide emotional and informational support; if the epidural doesn't "take" properly, she will definitely need your strength and ability to help her focus. Also, you should read up on different postitions that may be possible with an epidural to help the baby get into and maintain a good position for delivery.

HTH!

AmandaB · 08-12-2006, 02:45 PM

Abby,

The epi is not the end of your job. I have had 13 births and 12 of them have been epis. Your role shifts to an emotional support, most women are left on their own once medicated (staff can monitor from the nurses station and dad can crash). You are there to set the environment to one caliming and rest, turn down the lights, put on some music, massage her head (or hands). Also bear in mind the epidural does not always work and some women do still feel discomfort (so break out the breathing tech and/or visualization). You are also prepping her for the pushing stage, relaxing the perinium, visualize baby coming down and out. Some women get all shaky when they realize it is show time, so again breathing, get cool or warm compresses, getting ice chips.

This is also time for you to check in with your family, get a snack and if it has been a long night (day, whatever) then grab a cat nap, fill out paper work. I have had my share of epi births and you just need to shift your role.

I also would not dismiss her feelings "My client feels very strongly about using an epidural...in that she WANTS one if it hurts too much...which means she likely will. She's very scared of pain, and blah blah blah." I respect clients who are open to all possibilities, as birth things change so quickly and also the environment is a hard one to battle ... you know the drugs are there, so why not let them work for you? Help her get as far as she can, and if she is at 7cms when she is calling for the drugs, remind her that transition is the quickest stage of labour and to hang with you for another few contractions (get her into the shower). Alway tell her to use her BRAIN whenever things get out of control.
Benefit
Risk
Assesment (now or in 20 mins?)
Intution (what is your gut telling you to do?)

I am sure you will be fine, the fist birth is always the scariest and remember you are there for whatever she needs, including supporting her in her decision to get the epidural. Best of luck!
Nothing (what if I push passed this point?)

DL · 08-12-2006, 06:20 PM

Here are some threads that you might find helpful as well. My advice of how to help during an epidural is in the first thread below:

epidural/non-epiduaral??

How do I help?

When your client gets an epidural

ETA: 3/8/09-- I think that the first two links above were eventually merged into the When your client gets an epidural thread.

Abbydoula · 08-13-2006, 09:42 PM

Thank you for the responses and the links

Abby

doula Michele · 08-15-2006, 09:59 AM

We talk alot after the epidural..
Dad often takes a break then, and goes for lunch or a snack. So we talk about alot of things sometimes. Fears. Hopes. dreams. or sometimes we chat about 'desperate housewives"...but usually wehen we are left alone like that, that is when some issues come up for mom, and she often has a good cry.
I have been told lots of secrets during those 'epidural moments".
so while I am not doing labour support... I am still am giving a ton of emotional support.

Michele

abuela · 08-06-2007, 10:23 PM

I find that after the mom gets an epidural is a good time to talk about the labor so far (unless she wants to sleep, of course). Often she may feel that she failed in some way by deciding on an epidural, if she had been hoping or a non-medicated birth, which almost all of my clients do... So we talk about the special challenges of her labor, why the epidural is an appropriate choice given the circumstances... what she did amazingly well... blah blah blah, a debriefing and lots of support for her decision.

vickie_f · 08-07-2007, 12:28 AM

It has been my experience in many years of caring for laboring women that a epidural still allows for a lot of discomfort during transition. Most women don't feel the sharp contraction pain but a fair number of women still feel a overwhelming amount of pressure as baby comes down. With this pressure comes fear. They also tend to feel the hot/cold sensations, nausea and vomiting, anxiety that is a normal part of transition. Only epidural mama's have been "comfortable" for awhile and haven't had the chance to move into transition smoothly. For some mama's this makes transition feel worse. This is one thing I always warn my couples about if they choose an epidural.
So you see, in many cases, a doula is even more valuable with epidural moms and are still needed greatly at the bedside.

Vickie

missilla · 08-08-2007, 08:39 AM

a lot of the women i have worked told me the second they met me was i want epidural. I promise there will be a lot of stuff for you to do!!

mamamia2 · 09-03-2007, 05:12 PM

I've got to second what everyone else had to say. Moms who use epidurals deserve doulas too!! One thing I didn't know until I worked with my last client is that a common side-effect of epidurals is itchiness. I spent hours rubbing an ice filled washcloth over her arms and shoulders. (they gave her Benadryl for the itchiness, but it didn't seem to help much) It's a good idea to get familiar with the side-effects of epidurals so that you can be prepared to offer support (emotionally and informationally if nothing else). Trust me, this mom will be grateful to have had you there.

jc_doula · 09-04-2007, 08:52 AM

I just had my first doula experience (which was amazing!!) and she had an epidural. I was with her for 7 hours before she got the epi and then another 14 hours afterwards, she definitely needed me! She still felt the pressure of the contractions and it was very uncomfortable for her. She often panicked and I helped her breathe through them. Her feet were very tingly so I massaged them a lot and that made the tingliness go away briefly which she really appreciated. I used cold cloths on her forehead because she got very warm and yes, the itchiness was bad! Her chest was itchy and her stomach was very itchy where the fetal monitor straps were. I had massage cream so I used that on those areas and it was a lifesaver for her. She definitely got very emotional too, scared of what was to come. Her husband was so nervous and excited and just all over the place so she is so thankful that I was there for her. We laugh now about how much he ate and talked on his cellphone and slept. She really needed me to be there as she started pushing. Even though there was the nurse, midwife, doctor and her husband, I was the one at her head telling her she could do it and supporting her between pushes. And when the doctor said we may need to use the vacuum, she looked at me for an answer on what she should do and I looked her in the eyes and we decided that she was going to push this baby out on her own. I was so proud of her as she delivered her 9lb son after an exhausting 24 hours in labor!

So YES, there is still a huge need for a doula when the mom gets an epidural! Every situation will be different and some will need more support than others, but that will happen without the epidural too.

birthsister · 09-24-2007, 08:45 PM

I work in a hospital where epis are the norm, and are often pushed by certain nurses and docs. No family is allowed in the room while the epidural is being placed, but I can stay, so I become her only support then. After it's done, I help get her settled again, sometimes hold her hand while they place the Foley, and then let dad or whoever know when they can come back in. Sometimes I take that time to talk to her about her wishes for the actual delivery - does she want a mirror? does she want skin to skin contact? would she like me to help coach her or take pictures or hold a leg? does she intend to breastfeed? sometimes we talk about the nursery or things that are still on her mind. and sometimes, i even ask 'if for some reason a csec were necessary, what are your wishes at that point?' (I don't meet my clients prenatally so we don't have a preferences history.)

Shannon K. · 10-22-2007, 08:58 PM

I have a great epidural birth to share that somewhat changed my perspective of the use of an epidural. Mom had a great labor and dilated to complete basically standing and breathing through her contractions. She arrived at the hospital at 3:30 am at 5 cm and was complete by 5:30! I was so excited thinking we are going to have this baby soon ~ but alas these babies always have a different idea. Mom was suddenly hit by extremely painful contractions and suddenly couldn't get a grip on them. Her RN Midwife diagnosed an OP baby and suggested an epidural to let the baby come down without mom feeling the pelvic pain. I thought 'here we go'! Much to my surprise, it worked like a charm, baby came down in about two hours, mom rested and pushed baby out when the time was right. Baby was as sunnyside up as possible ~ but due to her wonderful midwife who used this tool to allow mom's body to catch up ~ was born to two very excited parents who walked away very satified with their birth experience. And this was in a hospital too! Unbelievable but awesome!

MissyLissa · 02-28-2008, 12:46 PM

Has anyone ever been asked to leave after their client got an epidural? A friend of mine is going to be my first client and I met with her yesterday to discuss what she wants (very informal prenatal appt) and she told me that she wants to try unmedicated but if she ends up with an epidural she just wants it to be her and her DH from that point.

I don't know how to explain to her that there a lot of things I can still do for her to make the experience better even with an epidural but I know she feels strongly about wanting this birth to be more private than her first. If this were a paying client I would be like, that's fine you're still paying full price for me!, but I also need this birth for certification so I'm really bummed that I may not get to check off one of my 3 births!!

DL · 02-28-2008, 01:16 PM

Quote:

Originally Posted by MissyLissa

Has anyone ever been asked to leave after their client got an epidural? A friend of mine is going to be my first client and I met with her yesterday to discuss what she wants (very informal prenatal appt) and she told me that she wants to try unmedicated but if she ends up with an epidural she just wants it to be her and her DH from that point.

No, I've never been asked to leave. If I were you, however, I'd reassure her that she is queen of the day when she is in labor, and that of course you will respect her wishes.

Quote:

Originally Posted by MissyLissa

I don't know how to explain to her that there a lot of things I can still do for her to make the experience better even with an epidural but I know she feels strongly about wanting this birth to be more private than her first.

After reassuring her about you respecting her wishes, then you could say something like, "As your doula, however, I would not be doing my job well if I did not give you a few things to consider while making your decision." Then you could educate her on epidurals (the benefits & risks, other interventions that may be involved, what's it's like when they work, what it might be like when they don't work, etc.) and some examples of support you still have to offer them in the event that she accepts an epidural. You could also let her know that birthing in a hospital is never "private", that there will be a number of medical staff coming in and out. Then, make sure to end it all with answering questions and again reassuring her that the most important thing is that she make the decisions that she feels to be best for her and her baby, and that you will respect her choices. Oh, one more thing: It's very important to NOT take any of her decisions for her birth personally, as it's not about you but about what she perceives an epidural experience to be like. Best of luck to you! I hope that she'll reconsider and that you'll get to be there the entire time, whether or not she requests an epidural.