Although good to excellent pain relief is obtained in 90% of
epidurals, few epidurals take away all the pain. There are several reasons why
an expectation of a painless childbirth may be unrealistic. Often you must wait
for the anesthesiologist to become available, sometimes this wait is hours
long. You may need to wait while you receive 1-2 liters of IV fluid. This can
take up to 30 minutes, and you may not have complete pain relief for another 20
minutes after it is placed. Once you are close to complete dilation, the
epidural may wear off, or you may experience breakthrough pain. In about 10% of
cases, the epidural gives only patchy pain relief, or doesn't give any pain
relief at all.
If you experience any of these situations, or if you prefer
to avoid using the an epidural until you are 5cm, or if you wish 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, shaking
and fever. Your doula will stay at your side, helping you cope with any side
effects you have, and helping to minimize the side effects and risks associated
with epidurals.
While an epidural relieves most of
the physical pain, it does not affect your need for emotional support,
information or reassurance.
You might expect that with pain relief, all your worries will
go away. Interestingly, this does not seem to happen. Women experience most of
the same emotional stages of labor whether they use epidurals or not. Many
times, the medical staff feels 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 that 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 ask questions. Epidurals do not get you ice chips
or remind you to use the bathroom. Epidurals cannot suggest position changes to
help labor progress. Epidurals will never advocate for you are help you get
what you need from the hospital staff.
Epidurals also do not guarantee that you will never be left alone, in
fact, it is more likely to happen if you have pain relief than if not.
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, and help you to
minimize the risks and side effects.
Make sure she is familiar with epidurals and how to help you (most
doulas are). 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.