“What do I do when my client gets an epidural?” When this question is asked of other doulas the answer invariably is something along the lines of, “You hold the space.” But if you say that to a potential client who wants a doula and an epidural, you may get quizzical looks and they may stop listening. So, what do you say? My canned answer is, “If or when you decide to get an epidural, the need for support doesn’t change, just the type of support will change. The support will move from less physical to more emotional and informational.” Now that they are listening, you can elaborate with more specific information.

What Does Doula Support Look Like With An Epidural

Emotional Support

1. When an epidural comes into play, there may be a sense of relief from the birthing parent, but there could also be a sense of disappointment or failure if the plan was for an unmedicated birth. Helping them understand that getting an epidural is not a failure but a valid option among many that are available in birth can alleviate feelings of distress or guilt. An epidural is a tool that can be used if the labour has become more than the birthing parent can manage.
2. It is also important that you make sure your clients sleep or, at minimum, rest while the labour is progressing. This way they can be in a good physical and mental position when the time comes to push baby out.
3. Occasionally, getting the epidural will cause an adverse reaction with baby and the need for other interventions or procedures. Helping keep the birthing parent calm and relaxed will help stabilize baby. Maintaining your own calm will help with that.
4. If your client needs to make decisions but is beginning to feel overwhelmed and there isn’t an emergency occurring, it may help to recommend time so that the staff can leave and your client can mull over in a more relaxed manner the options they have before them—as opposed to having people stand over the birthing parent while they try to decide.

Informational Support

1. When a client gets an epidural, and they may not be able to sleep, you can help by offering information on what to expect moving forward.
2. You can ensure that your client understands all the medical speak that may surround them and confuse them when they are asked to make a decision or encourage them to ask more questions, so they understand.
3. As the end of labour approaches, you can help by: discussing how pushing might go, as well as what to expect in the immediate post birth period, reminding them about your discussions on skin-to-skin and getting that first latch, and/or helping them communicate with the current nursing staff if there has been a shift change since you first arrived.

Physical Support

Physical support may not be as intense after an epidural goes in, but it will still be necessary.

1. Helping the birthing parent shift from side to side every hour to encourage or keep baby in a good position for the labour and pushing is very important.
2. Using a peanut ball to encourage an open pelvis and increase the space needed to move baby down for pushing is also vital when an epidural is in play.
3. Getting water and cold cloths for the birthing parent and food and water for the partner is important. A doula’s role is to ensure everyone is taken care of.
4. Holding your clients leg or supporting their neck and shoulders during pushing.
5. Simply being physically present and available is so very important during labour with an epidural so the birthing parent doesn’t feel alone while their partner is asleep or taking a break.

Holding the Space

And what about holding the space? Its not just some magical, hippy phrase that makes everything better. Holding the space means everything listed above. It also means keeping birth in the room. When birth becomes medicalized, its important to make sure, as doulas, that we try to keep the essence of birth, what birth is at its core—beautiful, powerful, transformative—in the room and surrounding the birthing parent and their partner. We do this by the language we use, the tone of our voice and the topics we discuss.

We also do it by keeping the partner involved in the birth experience too. Keeping them focused on the birth itself can help lessen the medical side of what’s happening and helping them see the power and beauty of what the birthing parent is doing and going through.

So next time a doula or a potential client asks you, “What do you do if an epidural comes into play?” You can give them a perfect answer that can guide a new doula or get that client.

Kimberly Fernandez CLD, CCCE, CPD, CAPPA Faculty Kimberley Fernandez is a proud mother of three amazing children. The birth of her daughter was the spring board to her becoming a Labour Doula with CAPPA in 2007. She followed that up with her certification as a Childbirth Educator and a Postpartum Doula. Kimberley believes strongly in doulas supporting doulas and mentoring new doulas on their journey through birth and parenting support. Kimberley currently trains both lbour and postpartum doulas throughout Canada as well as teaching childbirth education classes at several local hospitals. To date, she has assisted over one hundred families through birth and the postpartum period. She currently owns and operates The Toronto Doula Group with several of her Doula sisters and has been published in an anthology of birth stories called Bearing Witness: Childbirth Stories As Told By Doulas.