Many people think that doulas hate epidurals. NOT SO. At Carriage House Birth, we have a special place in our hearts for them. In fact our doulas often shine the brightest when our clients have medically managed births including epidurals.
TBH, if we could really have our doula dreams come true, every single person who is about to become a parent would be clearly educated about epidurals and the nuances of having one before they make the decision to get one. After all, we all know that if we dont understand our options, then we have no options. So below we answer some of the most commonly asked questions about epidural from our Carriage House Birth Childbirth Education classes.
Can I get out of bed if I have an epidural? Generally the answer is NO. You cannot. The idea of a walking epidural is a nice one but given that we live in a society that allows the medical community to be driven by insurance companies, pharmaceuticals and lawyers, fall hazards are very much a concern beyond the safety of the patient and deep into the pockets of the hospital. So while there is that four leaf clover of a nurse out there that will let you prove you are capable of supporting your body weight on those numb little legs of yours, most will not.
If I cannot get out of bed, how will I pee? If it’s looking like you will need your epidural for longer that say an hour, you will have to have a catheter in place to drain your bladder. This very flexible and sterile tube will be threaded through your urethra (the most anterior hole that you urinate from) into your bladder and will stay there until pushing with a very low baby.
What about number 2? It's not unusual for people who are laboring with at least one baby that is very low in the pelvis to have a sudden and overwhelming urge to evacuate the bowels when its near the end of your labor. This sensation is often just the baby's head but we see many people hit the panic button in this moment because they hadn't considered the possibility. But now you have! So box checked! And if you do actually have to clean house, that's what bedpans are for and your nurse should get you all set up with whatever you need to make it happen in a way that maintains some level of dignity.
Can I still have intermittent monitoring and stuff like that? Unfortunately no. Once you have an epidural, fetal and TOCO monitoring are continual, blood pressure might be taken more frequently, some places put a sticker or a little clamp looking thing on your finger that is attached to another wire that measures your pulse (pro tip: ask the nurse to put a pediatric sticker pulse oximeter on your toe instead! If you cannot get out of bed, may as well put it on the feet you can’t use so your hands can be freeeeeee!)
What is an epidural anyway? Well, an epidural is a tiny flexible catheter (a thin plastic tube) that is threaded through a needle into the epidural space in your spine. The needle is then removed leaving just the plastic catheter. Through that tube, your anesthesiologist can deliver a continual flow of of medications (local anesthetics and opioids or other narcotics) that will inhibit your ability to feel your contractions. An epidural might also be set up so that manual injections can be administered through the epidural catheter.
Will I be totally nub? An epidural does not take away 100% of the sensation. And thats a good thing! There are varying degrees of relief that people commonly experience. Some people still feel some pressure, and some people even have breakthrough points of actual discomfort during contractions. But for the most part, people are pleasantly surprised to discover that coverage is pretty damn good and that they can still lift or move their now heavy legs and wiggle their toes. We are taking a moment to highlight this because if you think it might feel good, we would suggest that you 100% call in a foot massage if that’s available to you at this time from your doula or whomever else is on your support team.
Will I still feel other symptoms of my labor? Yes, you might still experience sudden waves of nausea, get the chills, even vomit just like you might in an unmedicated labor. These sensations might feel really out of place, like its coming on “for no good reason” when in fact, your body is still very much at work along with your baby to bring them earthside.
Why is it so important for me to be in active labor before I get an epidural?
In order to answer this question clearly, first we need to talk about how contractions work. In very basic terms, the baby presses down on the bottom of your uterus called your cervix. There are nerves in the cervix that send a signal to the brain telling the brain that the baby has engaged the cervix and that the pituitary glands should release a lovely and generous hormone called oxytocin. Oxytocin then travels through your body to the smooth muscle of your uterus and tells your uterus to squeeze or contract (we like to think of it as your uterus hugging your baby). This little squeeze presses the baby down onto the cervix again and starts the cycle all over. This cycle is repeated until the contractions become long, strong and get close together which eventually brings the baby down and out.
Now, if we place a road block in that loop that prohibits the brain from getting signals, the lighter, gentler pressures on the cervix may not be sensed by the brain, oxytocin won’t be released, and the uterus won’t be signaled to contract. In other words, the labor could slows or even stops.
If your contractions are really big and productive there is a chance that your labor will continue without additional support from synthetic oxytocin (Pitocin)
You just said Pitocin. What is Pitocin? This is a medicine that is administered through an IV in very small doses that are increased over time to mimic the body’s build up of oxytocin.
We find that when people get an epidural later in their labors, once the contractions are very strong and have been rolling for a long time, that Pitocin, if needed at all, is needed for a shorter period of time and/or in lower doses.
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