The Epidural and the Doula
Think you don't need a doula because you're planning an epidural? I have a good story for you.
I recently attended a birth of a third-time mom who was planning an epidural as soon as she was admitted to the hospital in active labor. However, getting an epidural takes time. It has to be ordered by the doctor, the anesthesiologist has to be called, blood has to be drawn and tested for platelet counts, and then the epidural has to be administered. Immediate relief is not a guarantee – some take longer than others to kick in, and some don't offer the same relief as others.
So, in this particular birth, even though the epidural was in place about an hour after it was ordered, the mother I was with endured back labor along with a rapidly progressing labor for around two hours total, including the time it took for the analgesia to take effect.
Would you want to endure two hours of back labor and pressure in addition to strong contractions without any coping mechanisms?
I was so glad to be able to help her with positioning, massage, guidance, and reassurance. Some of the techniques utilized to help her cope were: hip squeeze, massage, ice packs, cold wash cloths, and guided breathing.
I mentioned that the mother was experiencing back labor. This occurs when the baby is in a posterior position ("face up") as opposed to an anterior position ("face down"). I experienced back labor with my first labor, and I can describe it as a "double contraction", so when you feel the contraction pain in your abdomen, you also feel it in your lower back. It is accompanied by a feeling of pressure as well. Contraction "coupling" or back-to-back contractions are also a sign of a posterior position, which the mother at this birth also experienced.
What does a doula do to help during back labor?
All of the techniques mentioned above, plus positioning suggestions. (I should note that depending on the environment, more or less coping options are available. These were the options at her disposal at this particular hospital.)
I encouraged this mother to be on her hands and knees whenever she was bed-bound for testing, awaiting anesthesiologist, etc. Once the epidural was administered, I helped position her on her sides with pillows to prop her in the right places to keep her pelvis open to encourage the baby to shift.
Thankfully for this mother, the baby did shift and back labor subsided. Soon after she birthed a beautiful and healthy baby.
The moral of the story is: doulas aren't just for unmedicated births. And doulas aren't only needed for long labors. Labor and delivery is inherently an intense process, both physically and emotionally, and having someone by your side who is trained on how to help you cope and thrive can make a big difference.