Do I Need a Doula if I Plan to get an Epidural?

Sometimes women think if they are considering an epidural they don’t need a doula.

As doulas it is not about us and what type of birth we want. Or what kind of birth we had personally. We are there to support women and help them to make informed decisions that are right for them as individuals. But, I tell moms if they would be sorely disappointed if they don’t get an epidural then I am probably not a good doula choice for them. The reason I say that is that many women who have considered an epidural an option, find that they don’t need one once I am there offering many other options in pain relief. It is not the doula’s roll to insure you get your epidural if you are not asking for pain relief and are coping well with the contractions. Many moms are wonderfully surprised when they find that they can manage without an epidural after all. Much of the pain experienced in childbirth is related to fear. The doulas support and presence can enable a mom to let go of her fears and enter a safe haven to birth.
If you have a doula, does that insure that your labor will be one that an epidural won’t be used?
Definately not, although the statistics state that it decreases the request for epidurals by 60%. But there may a time and a place for an epidural in some births. Are they overused today? Yes. Are there negative aspects to an epidural that you need to know about before deciding on using one? Yes. But if your labor is excessively long and fatigue sets in, or if you have a labor where you are failing to progress, sometimes it can be useful. If you have a non-natural labor, where you have to be induced, many times epidurals become neccessary. If you have to have a cesarean birth, you most likely would prefer an epidual over general anesthesia. For some women who have experienced abuse in their background, epidurals can ease the pain of labor. A doula is there to support the informed decisions you make.
What can a doula do once you have an epidural?
A doula may have arrived earlier in your home or met you at the hospital in earlier labor. She could have offered pain coping techniques that helped you get to the active stage of labor. This is the best time to wait to get the epidural if that is your plan. She can offer support in your decision. Many times women are disappointed if they had not planned on getting an epidural and end up making the next best thing decision and decide to have one. And yet by having a doula there you have knowledge that you have exhausted other alternatives before choosing to have one. There is the ability to delay the epidural until you are in active labor and therefore limit some of the negative side effects that epidurals can offer. She can assure that you get turned frequently so that malposition of the baby is limited. She can offer some massage techniques to help keep your contractions regular and not slow down after getting an epidural and therefore limit the need for pitocin. She is there to offer information and companionship during what can be a scary time. She can help when it comes time to push by offering some techniques for helping the mom to push more effectively. She is still there for photo taking and help with breastfeeding afterwards. And for the moms who have negative reactions to the anesthesia, shaking, nausea, windows of pain that the epidural missed, and itching, she is there to help.
So remember this is your birth experience.
But before making some of your decisions set in stone before the first contraction, know what other options are for pain coping methods, delay the use of an epidural until you are in active labor, and have a companion that is knowledgeable about birth there to act as a birthguide. Learn about labor and what to expect in labor. And understand that there are many unknowns in any labor. Having a doula by your side can decrease the use of forceps and vacuum by 40%, decrease cesarean births by 50%, decrease Pitocin use by 40% and shorten your labor by 25% as well as decrease the requests for an epidural by 60%.
Here is an article by another doula that explains why that is a misconception.
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 anesthesiologist 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 labor 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 labor 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 labor much smoother, leaving you free to concentrate on the birth of your baby.