Ep 92: All About Epidurals

When preparing for your birth, one thing to consider is pain management support during labor and birth.  It comes up a lot in Rachael’s doula work, and discussing in Dr. Shannon’s prenatal chiropractic office as well.  This episode is all about education, helping you make informed decisions when it comes to your birth plan and birth preferences.  

In this episode, we discuss:

• The pros and cons of epidurals
• Alternative easy to manage discomfort/pain/intensity during birth (also check out episode 24: comfort during labor
• The procedure of getting the epidural
• Tips for managing labor with an epidural (did you know you can still move!!)
• Questions to ask your provider

Resources:

https://evidencebasedbirth.com/epidural-during-labor-pain-management/

https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/what-is-an-epidural/

https://sarahbuckley.com/epidurals-risks-and-concerns-for-mother-and-baby/

Episode 60: The role of pain and hormones during labor

Transcript

1:43

Hello, this is the Align birth podcast. We have doula Rachel and Dr. Shannon here today and we are the team of the Allied birth podcast and today's

1:56

topic is going to be epidurals and a really good overview of epidurals and maybe like a good starting point for you as you are doing your childbirth education, your birth prep, creating the birth plan. What you want, what you don't want. And so, as always, we want to provide information that can then help you make informed decisions. So that's the big goal with today today is not a you should get an epidural or you should not get an epidural today is not shaming anyone for getting an epidural I had I have no shame. This is not this is not that this is really understanding it and again, coming at it from that educated, informed area and then you can make the best decision possible with all the information that you have. So because sometimes I think there's not well yet we know about it. Oh, we know it is a pain management tool for that seems to be the big like, this is what I know but here's what we're gonna go through. Yes, the pros of it. Some of the cons some of the risks there. What are some alternative ways to managing the pain surges discomfort during labor? The a little bit of the specifics of what exactly does it entail, like getting the epidural like the physical aspect of it, and then any tips that we have to offer or things to think about and then a really good one as far as what questions could you ask your provider to get some feedback on when it comes to epidural? So hello, Rachel, welcome to the show today.

3:50

Dr. Shannon, so good to be with you. I always look forward to our conversations. And I do I think no matter what kind of birth you're planning or hope for knowing about epidurals is really important. Even if you're like I want no intervention. I'm having a home birth or I want an unmedicated hospital birth. Like yes, focus on that. Also know about epidurals, I think it's like 60 to 70% of people actually end up getting an epidural with those getting birth. Whether they intended to or not, some people go in knowing for sure if you know if you're sure you want an epidural still like learn about it know about alternative ways to cope with pain until you get to the point of getting epidural because you don't just start label labor, get the epidural. And if you know you don't want it then you still need to learn about it. And I know that that's really hard. When you are wanting to stay in a certain mindset and stay focused on a certain goal. It's not about like focusing on what you don't want. It's about being prepared and being prepared to navigate whatever arises because you can't guarantee everything and birth and knowing that it can be a helpful tool when used judiciously so not being so scared of it in case you do decide you need you can avoid any feelings of disappointment, right and

5:07

not being like blindsided by like, gosh, I had to get an epidural and you know, you don't know what all is involved. With coming

5:13

Wednesday. Yeah. Yeah. So you know, I think an easy one is to start with some of the benefits or pros to getting an epidural. Some people might have the opinion that there are zero benefits, but I think if we're being honest there are benefits because it can and does for most people provide pretty effective pain relief from the discomfort of labor. Now, you know, pain during labor is normal. Most pain suffering during labor is not. So for those wanting to avoid an epidural, we say aim to stay coping well stay on top of your contractions and if you feel like you are shifting into suffering, that's a good time to consider the epidural because suffering is a psychological experience and that can cause trauma and long lasting negative effects. So like if you're shifting into suffering, then maybe now's a good time to get an epidural. So just being open to it. Because it isn't a it can be an effective pain relief tool. It doesn't take away all the pain but it takes away most of it. Most people can usually get a decent nap and and feel a lot of relief from the discomfort that they were feeling before. It is easy to access and most hospitals. So that's also a benefit. And it can maybe possibly promote progress and a previously slow or stalled labor. It also can slow or stall labor if given too early. But I have witnessed this myself and I know it is that it's been a long labor or they're struggling to cope well. Sometimes just some sleep and relaxation. Gonna say

6:59

that Ralph's to buy allows that rest Yeah, and I remember that. Mine is like as far as you're trying to labor for so long without it, but then, you know, knowing the possibility this could continue and I felt like I was switching into like, I think I'm suffering you know, so.

7:16

And that's important to be able to recognize that and that's powerful and knowing that it's like that can happen, right? That pain during labor is normal. Here's some tools to use being familiar with ways to try and cope with the pain or intensity or surges, whatever you want to call the contraction. But the if it shifts, that's a good time to get it. So that is that your experience did things progress pretty quickly after you got your epidural.

7:43

I'm

7:45

not necessarily but I remember resting like as soon as

7:50

needed the rest for mental state. While also that has been a bit too

7:54

it was a lot of I mean a good there was a lot of interventions as well, because it was like, you know, had been put on Pitocin because it wasn't progressing as expected or desired by providers. But then also some of it was the mind games. of hearing that you know, like coming in for cervical check and being like, oh my gosh, I'm only at four or something like that. That was not fun. And so that played that mental game and then it was the aspect of like, okay, if we're going at this rate it's potentially going to be this much longer. So those were some of the words and statements said surrounding that. So again, to not that it was like ideal.

8:45

There's some other factors at play. There were some other factors at play,

8:48

but that those things kind of turned me into that, you know, several people

8:53

do lean towards the epidural if they do have one or several objects that are making them feel like they're not progressing in the right way or fast enough. Absolutely. I don't want to do this anymore. That's totally understandable. But yeah, I mean, early labor is the longest part of labor, right? Getting the six centimeters takes the longest and there's a lot of start and stop and active labor used to be considered at four centimeters not six, because we know they're still kind of like a big chunk of time between four and six that can be unpredictable or contractions still haven't maybe formed that consistent pattern that's going to effectively progress labor. So you know, understanding that and then trying not to be labor manner will be recommended, but it's understandable when it happens. But we're like, you know, we've seen people go from four to complete really quickly, but we've also seen people go from four to six and it take hours like you just you know, it's you don't know we don't know exactly how it's gonna go. epidurals can be helpful for getting rest, so that you have the mental space and capacity to finish the birth because how you feel throughout the process really, really matters. So thank you for sharing some of that. So we can move into I'm in the list of cons or downsides for those like it's longer and longer than the

10:11

pros, but I think I mean, you get it I don't know if anybody talks about

10:16

it doesn't even talk about any of the first thing is that they are relatively safe. They are for the vast majority of people very safe and effective. But they're not without risk, just like anything. So we'll go through some of the cons to getting an epidural so restricted movement. So you may not have pain, but you're also going to be numb from the abdomen down. And so therefore you are restricted to the bed. You can't walk around, you're not walking around yet. You're hooked up to more things. You have continuous fetal monitoring, so get the belly bands on to have them. You got IV fluid line going which is another line going ot oh two thing on your finger measuring your oxygen, blood oxygen counts, and then a blood pressure cuff going off every 10 to 30 That

11:13

was that was the biggest Yeah, I remember that the most.

11:17

Yeah, if your blood pressure reading is off, it's gonna go off every 10 minutes. If you get it like consistent, living good blood pressure readings for the first few then I think you can do it every hour, but it still stays there and it goes off continuously

11:34

I yeah, I did not like that. So yeah, you're still resting but I did not Yeah, I remember

11:40

your tether more and I think that is one thing that I witnessed a lot of people they didn't learn about it going into. They're taken by surprise. Like I didn't I knew that. Oh, I did.

11:49

All the other things that come with it. I don't think a lot of people were I know that.

11:53

Right? And it does disrupt the hormones of labor, right. So you have there's a beautiful orchestration of hormones that occurs during labor that helps labor to progress and protects the mom and baby and sets up for breastfeeding. Like all these things are flowing and the hormones are there to to help you cope with the pain. So I mean, oxytocin is the main homophone of birth is the love hormone, you know, it's released in the brain and you have oxytocin receptors on your uterus. And so it's a, you know, this cyclical event and it builds up over the course of labor. And so the oxytocin, you know, they keep filling in those receptors on the uterus so those contractions can get really, really strong. And when those contractions get strong, you know, the intensity of the experience goes up, but then so to your endorphins, so you have endorphins that are your natural morphine, that are going to increase it, you're feeling more pain, and they, you know, oxytocin is helping the labor go balance, balance. And then once you once you get an epidural, right, that interferes with the production of oxytocin in your endorphins and completely makes the endorphins stop. Oxytocin keeps going, but it can slow down in production. Once you get an epidural, which is when they might introduce Pitocin there's a little bit of a cascade of intervention there. Sometimes Pitocin leads to epidural because the contractions are so impossibly strong and hard that you need the epidural and then sometimes the epidural leads to Pitocin because the epidural can slow labor contractions so you can have a longer pushing stage. This is typically because you're just movement is restricted, and we get the baby out.

13:45

And if you're restricted to and I remember when we did that interview with Latoya, who's a local doula, too, and she was talking about, you know, dealing with providers and saying, Well, why can't she move and like, well, there's the issue of that she might fall she was like, Well, if that's it, can we get her on our side to push better because otherwise, if you aren't, then you're just pushing on your back. And that's not necessarily using gravity to advantage it's not allowing for optimal shape of the pelvis to actually push baby out. So there's, yeah, there's that aspect.

14:23

The pelvis is bony. The baby's head is only like you need movement, like you have lots of ligaments in your pelvis and with the help of the relaxing hormone are able to expand and move further than they do normally, and in the baby's head molds and the baby rotates because your pelvis is sort of like shaped like this. And so the baby doesn't just come straight through like it has to turn to come through. And in order for it to facilitate that. You need some movement. And so again, you can have an epidural and not move and your baby's still come out. So like this isn't to say it can't happen. But like if your baby's posterior, especially meaning they're facing your front, like their back of their head is to your spine. It can be really, really hard with an epidural.

15:09

That's what I ended up with. Yeah.

15:12

And we're sharing the tips later about moving with an epidural. Should not be fully restricted. There are still opportunities to move and that's what Latoya was talking about, because she was like trying to get her client and some different positions and getting some pushback they were worried she was gonna fall. Yeah,

15:29

well, I get it but that's what she asked. He was like, Okay, well, what is the big risk here? What are we so we're preparing so when we understand what that is, what can we do? Yeah,

15:38

right so longer pushing stage. Another risk is concerning changes with blood pressure and baby's heart rate. So tends to cause hypotension. So a big drop in blood pressures if you already have really low blood pressure. So that's something you would want to make your provider aware of, because it can dip further and then that may end up getting oxygen or other drugs to help bring everything back up. And it can make you feel really lousy. Low blood pressure can make you feel really really crummy. So you might feel nauseous and shaky might like you might throw up might happen. It can be not a great feeling. There's also a potential for fever with an epidural, especially once you've had it for a while. And so when you when a fever is detected, they will do antibiotics prophylactically. So like, they don't know what's causing the fever, so you're going to end up with antibiotics regardless of knowing the source of the fever. In case there's any infection going on, because it could be an infection or could just be the epidural. We don't know so you get antibiotics stressed

16:48

out nervous system. Right.

16:51

So that's the downside because then you end up maybe with antibiotics you didn't need. So, challenges of breastfeeding can also be at the downside because of the disruption with the hormones. And you know, babies tend to be a little bit kind of slow to start with an epidural. You know, they say that it doesn't cross the blood brain barrier. But any medication you take does impact your baby. So if it's not like detrimental, but there can be a slow to start, like they might just might not be that interested in feeding initially. You're also more restricted because you're not able to like move your body in the way you maybe want. To move your body. And so breastfeeding and that really just is like you get an epidural, just know that this might happen and be prepared to have some extra support for breastfeeding after the birth. Other like not so fun side effects, potential spinal headache, itching, nausea, vomiting, something very fun thing. The other thing that I think people will get surprised by and you should share here if you have any experience with this is it may not work may not work effectively. Or it only takes on like one side or the one side before to Yeah, and that's sometimes just like it or how your body responds or how it was placed or you know it works with gravity. So if you're like lopsided and on one side too much it could all go to that one life and then it should be able to be balanced out. But for some people, they just don't get the relief that they needed or wanted and in order to rest effectively.

18:34

Yeah, I remember so first time I was able to do it. I but with Dylan. I think I was like right on the cusp of not it not being an optimal time and kind of being that like, Oh, it's too late type of thing. And that when we get into like about getting the epidural I just remember having really really intense contractions and then trying to like sit in that seat shame. I was like I'm I'm gonna die. Like I can't get it and then getting it and being like, so did you did you do it because this is not and so then you're hooked up and you can't move and it just didn't feel as effective. Yeah. And I was like, yes.

19:23

This is what I take some time to take. Yeah,

19:27

you take some time. You know, I don't like to say that. You know, Sandy was like scaring anyone or anything but I just remember that being that very vivid experience that second time. And so in my mind I was like, I was just not even like, done it and we've just been able to like move around more. But

19:45

enough times we don't know until you get it

19:49

because I didn't feel very good that like what I did that first time around where I was like, this is like second time it was just like, oh, this is

20:01

but yeah, I've witnessed it enough times to where I definitely give clients a heads up and like if you want an epidural, please know these things and if it doesn't work, that's a real mind mess. Because like you've worked hard to get to the point of not getting an epidural but then you decide to get one and then you don't get the relief that everyone's telling you will come from that epidural. That's hard. That's very hard. Yeah. So you know, you might get like hotspots like where you just kind of feel pain in one spot and it just won't go away. They can sometimes we do the epidural or you know, bolus it to help up the dose. There's some things that they can do, but that's definitely a challenge to navigate and to be prepared for. Yeah, I think I said this this earlier, but any medication that you take to relieve pain will reach the baby. Small amounts of medication can reach the baby and can cause fetal heart distress and can also cause the baby to be less responsive or reactive immediately after the birth.

21:01

Yeah, mom's comment on to having two different birth experiences and one was an epidural one without and then commenting on

21:10

their baby. And just like that post birth aspect of thing of things, which I thought was pretty interesting and pretty fast, really

21:18

wild because I've witnessed it too, between seeing where the different birth like with an epidural with an epidural and what's really hard. And I'd love to maybe sit down and have an interview with a anesthesiologist and every anesthesiologist I've been fortunate to interact with have been all really, really kind, gentle, helpful, you know, it's not a knock but they always say because mom always asks is there any harm to the baby and they always say so definitively, no. And I was like, that's not what I'm witnessing. I know what it seems like Yeah, yeah. And I'm it's an anecdotal thing for me to say like based on what I see, because then the doctor who has the training and is like, well, the evidence says it doesn't harm the baby. And I don't know if it's harm that I'm seeing but more just like delay in that like responsiveness and that reactivity and maybe some dips in the heart and and then maybe a slow start breastfeeding and it's hard to say that that doesn't cause any stress or harm. So you know,

22:23

and it's hard. It is hard and I've dealt with some moms too, who, even after like, coming in for postpartum care and still having like issues at the epidural, sometimes Yeah. So

22:42

absolutely three lingering spinal headaches, lingering pain at side of putting where the epidural went in, and it can't be the site and it can also be like in your hips, like on one side or the other or sciatica things, you know, and that can also just come from birth but it can also come from the epidural. So yeah, so that's our list of cons to getting an epidural or things to consider or be aware of again, it's a scary lazy, doing steam epidural, be really effective and work just like you're supposed to do and mambilla pushing in a different position and all things go well, it's not it's just things to be aware of. So when they come up here on line five, and just like you said, it's like, just trying to prepare

23:27

in a meaningful way and what do you feel comfortable with? You know, like knowing all the things what do you feel comfortable with? Yeah, but there are some other alternative ways to manage pain to discover and I think knowing those can be very alright, but

23:42

the epic girl and that's it. The only way to cope.

23:45

No, no, and so, II and I've spoken a lot before but knowing you know with both of my birth, I did not have doula support. And I do think that that would have played a role in being like, oh, I can try this movement or I can do this or this can help you know, and knowing that a little bit more obviously knowing that preemptively and like childbirth education, but yeah, when you get to the point of labor and birth sometimes those things go out the window in your mind. And so it's nice to have that person there to remind you remind you immediately

24:20

have birth doula listed at the top of our list for alternative ways to manage and discomfort the pain of labor, or marriage pain, so yeah, I mean, it's actually scientifically proven to help with coping and managing pain during labor and decrease the use of narcotics and epidurals during labor. So doulas, you know continuous doula support is very beneficial with all the things you just did, and also really helpful. It's not just about helping you avoid or not get the epidural. It's about helping you learn about it prenatally, have a plan the preferences and plan in place of like, what you desire what you want, and then helping you cope. And using all the things movement, breath vocalization, changing positions, using water all these things, until you get to the point of like, I feel like I've like crossed that threshold threshold. I'm no longer coping well, and then the doulas can also help do that and say okay, do you want to keep going? Do you want to try 30 more minutes? Do you want to ask your provider some questions about what it looks like to get an epidural? So you can kind of start warming up to that process and give them the tools they need in that moment? Because like you said, for a lot of birthing people, they're like front thinking brain dead. And so and that's what you want. You need that front thinking brain into them so that the primal brain can take over and labor do what it needs to do. But you're not necessarily in the like, where with all that you are during pregnancy to make the decision. So we're just there to be like, hey, here are some questions you can ask here are your options. We can keep trying to stay here for 30 more minutes, see if it gets better or you can get the epidural and guess what? We got you through that too. Like we can help with comfort during the epidural and changing positions all along the way. So like that doula through all without the epidural with the epidural is really, really helpful. But I'm kind of biased. So ya know, a little bit biased. But I did drop some of those other things in there like for the alternative ways, so like movement, changing positions, focused breathing, using aqua therapy so shower.

26:27

Moms that love or what? They want the water and I hear a lot of once I got in that water that's why here and the postponed water and that water in that and I just think that's

26:40

the goal. Yeah, and I can relate in my first it was the shower. Like I use the shower for rhythm just like the shower, the water running over me and over my belly. And I came up with like my little ritual in the shower it was like forward facing for the contraction and then I would turn around between the contraction and kind of you know, I like have this thing going because I was in the hospital for my first and I wasn't able to get the tub yet I was just wasn't progressed enough. And then as I did that I use the shower until I can get in the tub. So water was like water. And for me, especially with my first warm and cold compresses and heating pads can do really nice so sometimes lower back is good for like a warm compress and then like upper like my neck or face or chest is like a good bracket cold rag. So kind of working with those in that way. Massage. We all know massage is tremendously beneficial. So your partner can jump in and do massage. If you have a doula they'll do massage

27:42

that counter pressure and everything.

27:44

Pressure you have so putting, just like when you have a headache can count on a squeeze your school just to get relief. We can do that on the hips, because sometimes you just need to help the pelvis go back to where it was just to get some relief. Or you can press on the sacrum. Press it back into the wants to kind of move out as the baby's descending. So I'm a hands on support can really help people during labor. Some people don't want any hands on support and that's fine. I just want people to be present. The thin tooth comb, so like a very fine tooth comb and squeezing in your hands a great way it's like a hate theory. Approach kind of disrupts the signal to the brain and pain. So I'm gonna having a contraction you can like squeezing starting to like causing

28:27

pain somewhere else. Yeah,

28:28

yeah. It's like a pain that feels good. Yeah, labor feels good compared to what I'm feeling in my abdomen. And

28:35

yeah. When I think about that when well we had when I did Sara's birth story, and she's the one that ended up with that as part of preeclampsia. She talked about she would squeeze ice cubes. And she really liked that. And so that's kind of saying Yeah, interesting.

28:54

The brain a little bit. 10s units can be really helpful. 10 units. If you desire to use a 10s unit during labor, definitely learn about it during pregnancy. You want to start using it during early labor and build out so it's a like electrical nerve stimulator. But since small electrical impulses to the affected area, a lot of people in labor puts on four or two pads on the lower back. And it's just like this little tingly feeling and it distracts it's like right there in the spinal cord so it distracts the

29:32

pain receptors. And it's like it you can't you know it can't focus any more on that and people use them. I mean, you've heard of it like outside of birth Yeah. To my husband has he uses for his low back when whenever he jumped up so yeah, but yeah, I know a lot of moms have used that or like, again, it's not for everybody. But

29:52

I think it's good to explore if you're like I really want to have some alternative methods and it's in your toolbox and some people get into labor, and they don't like it. And so if there's no real downside to attend units, like you try it and then it doesn't work. You take it off. There's like no residual side effects. Exactly. It's like it's just something that again, toolbox. So yeah, also to take into consideration is your environment like setting the tone, like so how we feel like when you're stressed out usually bright lights, and sterile smells or arrangers tend to make that experience feel more stressful or painful. So what makes you feel safe and comfortable? So setting the tone whenever you Dimming the lights or opening a window or clean blue lights or essential oils or music I like a sound machine or headphones, something to drown out the beeps and the noises that come from the hallway. That cannot also help reduce pain. Because when we feel stressed, we experienced pain. More it's Yeah.

0:00

Okay

0:19

if there's no real downside to 10 units, but you try it and it doesn't work, you take it off, there's like no residual side effects. Exactly. It's like it's just something to again toolbox. So, you know also take into consideration is your environment like setting the tone like so? How do we feel like when you're stressed out usually bright lights and sterile smells or strangers tend to make that experience feel more stressful or painful. So what makes you feel safe and comfortable so setting the tone to either be Dimming the lights or opening a window or twinkly lights are essential oils or music I love like a sound machine or headphones. Something to drown out the beeps and the noises that come from the hallway. That can also help reduce pain because when we feel stressed we experience pain more it's

1:10

more intense like you know, and I want to mention too, it reminded me of there's this chiropractic book like it's called well adjusted babies but then talk about prenatal labor and birth as well and then looking at, you know, moms under chiropractic care and needing less you know, medical interventions but also less need for narcotics or pain meds as well too. And really looking at you know, yeah, making sure our nervous system is functioning well but like if we've you know, if we've got things wind up and we're impacting the structure of the pelvis and the sacrum, then that can also facilitate

1:56

as well. Yeah, absolutely. And you want to facilitate labor. You want it to progress so that you're not having to stay there too long or on unnecessarily long. Okay, so we wanted to also kind of talk about what it looks like to get an epidural sort of like walking through the steps of getting an epidural because again, if you haven't learned about this, prenatally when you're in the moment, you are in intense pain and the anesthesiologist in orders deliver the information very quickly. Yeah. Just talks in a way of like how you were listening to the like a prescription drug commercial, and at the end

2:39

of it, how they steal all the information and micro machine and dating.

2:44

Yeah, and I'm like, I know you don't have a lot of things to do with this. So we'll give you a little bit of information, but it's still important to say hey, you said that really fast. Can you like slow down and tell me more or ask her specific questions? Some people get really nervous without asking the doctor questions, please ask them questions. Again. Most of the ones I've encountered are all really nice, folks. Yeah. Their student agenda with mine were amazing too. But yeah. I like to break them out of their routine. So something something that I think take people by surprise is the fact that you might say, Okay, I want I'm ready for my epidural. And then you don't actually get relief for like an hour to an hour and a half. Or like you don't actually give the epidural and then there's time even after getting the epidural that has taken back. And one of the things that has to happen if you haven't already had fluids is you need two bags of fluids in your body before they give you the epidural and that can take 30 ish minutes. So that alone is like you know, so if you're starting to like consider an epidural, the nurse might say okay, well, can I go ahead and start your fluids that way? When you're ready for it? You're raring to go, but that also was like one step closer to a little differently about that. Yeah, but you can move with the fluids right, or yes, so. But yeah, and once the fluids are in, you can take the thing out and be completely free and if you get the fluids, you don't have to get the epidural. It's like sometimes it's like good to go ahead and get it. Like I just wanna be one step closer. Sometimes we were like, I don't want to take that step because then that means that one step closer. Mine days, they say things like all of us we need to bolus fluids. And that's like one of those phrases that people know what that means is they're gonna send the fluids app to your IV and run them through pretty quickly as quickly as like your veins can. What see okay, so, some people are like Is it painful? And you should tell us about your experience, but I did want to share that while the needle is long. It's very thin, so a diameter of like angel hair pasta, and it shouldn't hurt when it's being placed. That doesn't mean it's not uncomfortable. Do you want to share about your experience with the actually

5:06

it was worse trying to sit and be in labor and this big ol belly and I'm trying to sit and like a C shape because they you know, obviously I want them to have access to everything that they need to get

5:17

like your feet over the side of the bed. Pillow and you're kind of like a C shaped curled down pillow just grabbing the hardest part. Yeah, while you're in labor. Yeah,

5:27

I thought that honestly was the hardest part. I don't remember. Feeling anything I remember. I feel like I remember like it being cold. Like you know, it was you almost feel like if you or when you do get IVs or something like that and you feel like Oh it feels cold rushing through you. I I feel like I remember that the most but I don't remember it being like painful. It was painful, like and be still and I'm like, I don't I don't understand what that means right now. You know, like, that was the hardest part, which I guess that was actually nice. Maybe that was very distracting.

5:58

We're gonna try and walk you through verbally like how to sit, how to breathe, what to do with your shoulders and like how to kind of push your back out and how to stay there like you're now you're gonna feel like kind of burn or now you're gonna feel like cold and now you're gonna Yeah, they kind of try to walk you you're gonna feel I'm cleaning your bag or I'm taping your bag like, typically that's my experience when I've gotten to be there. Sometimes they kick the door out. But when I get to do that I get really excited because I like to watch the whole process.

6:24

But when you Yeah, walking them through it like and I do remember that. I don't remember it at all with Ethan. I don't think it wasn't as intense because I had been in labor for 18 hours. And so I think I was just so tired at that point. And I'd had the Pitocin I don't think the contractions were as intense but with Dylan like I said, I think I was on the cusp. I kind of wish they'd been like, you know, we're kind of at the point because it was just a lot more intense that and that was you know, Ethan's birth was 27 hours and Dylan's was just seven so like even then we got to the hospital. I was a little bit more progressed, like all further into it. Yeah, so there was differences there, but I remember IVF I don't know I vividly remember that second time around. But then even when you think of the word, epidural like epi kind of meaning like above and then dura is like the dural. It's the dura mater that surrounds the spinal cord. So that's where part of the name comes from to like it's cool. You're not going into your spinal cord. It's

7:31

kind of freaked out about this. Right, right, like

7:33

and that's why they have a specific space that they need to get it because of those spinal cord dynamics within the lumbar spine. So yeah, right. That's also why it has to be there. You know what I mean? Because that's where it got to be able to open up that distance set. Yeah, all those things make sense.

7:54

Right. Right. Yeah. And I think it's cool to know that and I think some people have fear of needles or kind of like, look at it, they don't want it. We hear like, Oh, we're scared or you know, what am I this is not like a needle when you get one drawn. It's just not and you don't even see it.

8:09

I was like I don't Well first I didn't want to see it. Most people plus you're in this little you know like you're never but yeah, I

8:18

always kind of friends with nurses. I pull it out and and they're like Look what was in your back. And I was showing people HashMap one can read that last one. Yeah. And then after you've never done all the other works with gravity, so you have to lie flat for like 45 minutes to an hour to let that the epidural try and take a good balanced effect. And then they make sure it doesn't creep up too far for kind of testing making sure where you're still feeling things and where you're, you know, all good during that time is kind of just emmalin doing bright blood pressure readings during that time making sure you're you know, all is good so like, you don't really get to settle in for that nap or rest until about an hour after the epidural. They will also place a urine catheter because you can't feel any heat going out of the bed so the urine catheter helps you keep your bladder empty which is good to ensure labor progress and but again, some people are taking by surprised taken by surprise being like another thing they have to have. And I think I already said you have to have a continuous fetal monitoring so to belly bands, IV fluids blood sugar so to monitor and so and with the pain like it doesn't, you don't feel the pain of labor, but you do still feel pressure. Like as the baby moves through the pelvis, you still feel something's happening but it's not typically in a very painful or unmanageable, right

9:52

and so you still feel like that urge or like you know, like, I feel the pressure I feel the urge to need to push and you can still push it's a very sometimes today it was just is can be a very odd, you know, feeling. So yeah,

10:07

and some people wonder about knowing when to push and again you still feel the baby moving through your pelvis and the one I tend to see and here's a good indicators when you feel pressure during a contraction, and between contractions and we say pressure. It's like rectal pressure, vaginal pressure like it's feels like you kind of have to poop. Nurses last I want to feel like you have to poop and I am not so much or if you say yes, and then that feeling goes away between contractions Okay, well, we're getting closer, but babies maybe not all the way down there and you really want to wait until you have that constant feeling of pressure, really labor down as long as possible before you start pushing because you have her baby so kind of high. You begin pushing my push for a really long time. It is given continuously. Once you get it it's on a programmable drip you're given a button where you can might get a little bit of a boost and then you can max it out and you can do that so much. Yeah. And then when it runs out, they replaced it before going all the way run out ran out. So you might have multiple, you know, don't replace them. You know they are the

11:22

right it's just the actual except Yeah.

11:27

And then they run that continuously until after the baby is born and it wears off anywhere from two to eight hours after you give birth. So you're still gonna have some lingering pain relief which can be good. You might not feel all the effects, like the bruising of the swelling and the pain from your birth until that wears all the way on.

11:50

I remember it being weird with the placenta part, you know and that fundal massage and that push and delivering that. I remember that being different, and just definitely feeling different than I think it probably normally does.

12:08

Yeah, like it felt weird because you were numb.

12:10

I think so. Yeah. Yeah. Yeah.

12:14

And you can ask your provider like hey, how do you manage this third stage of labor which is burning mental center when I have an epidural, like, what's that look like? You know, do you have to do manual massage? Do you have can we wait for it to come out on its own will or will be the reason you would do unnecessary or a lot of fondant massage or any sort of intervention versus just like waiting for it to come out on its own. Um So some tips which maybe we've covered them through here but you know, getting the epidural if you decide to get it sometime at or after six centimeters is recommended because that is when you're getting into active labor and less likely to slow things down to the point of where like you would need maybe another intervention like Pitocin. So having a plan for coping with the pain and discomfort in that early part of labor, getting the six centimeters and then sandpaper but if I knew I wanted more by the time we get it kind of aiming for that. And you may not know if you're not getting cervical checks how far along you are but just kind of really waiting until you're well into labor that there's good strong contractions that are getting stronger, longer closer together, you know, four or seven minutes apart, lasting for at least a minute and you've been doing that for a while, you know you don't get a cervical chip, that's a good indication of where you're at labor, so that'd be a good time to get it. informed your care provider that you want to delay the epidural and communicate your pain management preferences with the nurse staff. So birth you know a birth preferences plan. If you know you want it or you know, whatever you're deciding just communicate that with your care provider and the staff at the hospital and if you know you don't want it or you want to delay it, tell the staff not to ask if you want it until you ask for it. That's really important because they'll just advertise dangle the carrot in front of you and they're Hey, you want to I get that, too do want to get that URL but communicating clearly with the people will help reduce that temptation if that's your wishes. Stay active with your epidural. This is possible. Talk to your nurses about helping you move and change positions during labor. To keep baby and your pelvis moving. And we kind of already talked about that a little bit earlier about why that's so important. I

14:28

wish I had done that more. Yeah, or asked about that because I think that that would have felt much better.

14:33

Better. Yeah. Nurses can help doulas can 100% help and want to help nurses are in and out. So they don't have them Anessa get you in a position that they then have to leave you in but having you know partner their doula there we can kind of be next to you and help you. So what that looks like is like maybe getting a sideline position with a peanut ball or sitting up in the throne position in the hospital that which is like your back kind of really straight up and the lower part of the bed lowered. And your life sort of like tail wagging a flat like your knees sort of out. That's the Taylor crown or throne position. You can get in hands and knees either. I've seen that before. And depending on some people have a lot of mobility in their life and some people have like what's like dead legs like no mobility, so if you got like nothing their hands and knees are not going to be an option. If you feel like you can lift your legs and at least once your legs are under you can support yourself, then that can be a position to try not to stay out there. Stay in that position for very long, but it's one you can try and think about like if you could like rotate like you do sideline and then thrown and then sideline on the other side, and then maybe getting the hands and knees or laying over the back of the bed and then go back to the sideline. Like you're doing this like every five or so cycle. Yeah, and like every five to 10 contractions or something like that. Change it up helping the pelvis move so the baby can wiggle through and you know it's it's Do I

16:00

think that is important to know that you can move though I think

16:03

yeah, and you should move with an epidural even more so. And that's what we tell a lot of our clients who are hesitant about getting an epidural, we try and take that picture that if that makes it less scary to get my app, you know, because like it's not, it's not an end to a great earth like we're gonna just like keep doing this thing and keep focusing on what we can and maybe the epidural is what you need to get some rest and relaxation and that's okay. But you do everything you can to get to that point and then keep moving with it. Take a good long nap. Like as soon as you get the epidural because that's usually when it's like the heaviest and then we will get we'll get your move and move in. Yeah. Let's see pushing with an epidural. We kind of just started that a moment ago. And just wait until you have that constant, um, like controllable pressure down there to begin pushing and ask your provider about how they support laboring down with an editor. Not all providers support it.

17:04

But or they might support it differently. Yeah, I'm wondering if it's more they want to be in control and say this is when I'm going to tell you when to push or is that horses? Yeah.

17:16

And I say you decide I say labor down until it's just like in regular labor. Like when you're on your medicated like you're pushing only when your body's telling you to push that one you're a certain centimeter. Trying to wait for that with an epidural to can really reduce the length of pushing and reduce risk of tearing and reduce like a lot of other things. So but you got to make sure your birth support team like your, your provider who's going to be supporting you not controlling things, but that they're on board with your scopes or your preferences.

17:51

Definitely. Um, I think we talked about this a little bit, but just some of those questions. To ask him kind of just segwaying into checking in with your provider on what you were saying how like that pushing down stage but like, the movement with the epidural, like what Latoya had done with one of those clients is go to is kind of like okay, well explain to me the risks of that. Can we move? You know, our How do you support me wanting to move with the epidural? And seeing, you know, there's other like, and we talked about two other pain management things, but there's other pain management medication outside of epidurals as well. So, checking in with those what are the options? What are your thoughts and feelings on it? You know, like how does that make you feel? Do you want to use those things but communicating that with your provider

18:44

to you at that birth location. So you got to ask your provider like at this place, I'm not giving birth there before you know is there I'm spacing on the whapping gas nitrous oxide

18:59

outside Yeah, yeah, I know. We've had Yeah, I've seen lots of moms tried to search for that as well. Right.

19:04

Like it's not at all the birthing spot. And so like that's, that comes up when you're looking for alternative ways like you're doing some resourcing or researching before the birth that might come up. And you might think, yeah, I want to use nitrous oxide during my labor and then it's not at your birth location. Then you're like, Wait, so talking to me, yeah. What do we have like they can do a nerve block or you know, I mean, narcotics, if you're into that, what's that look like? What's available? So yeah, I love that question.

19:36

And then even asking them as far as like the risks and benefits for mom and baby too. So yeah, might be well versed in that but also, not only wanting to know the answer, but how does the provider answer that question as well? And do they answer it to your desires like is that they give you enough information, or? I don't know, do they leave room for more questions? Right, and kind of reading the response a little bit. As Yeah, with that. Yeah. That can be that can be an interesting, I think, to just kind of being that it's okay to ask providers, questions. And so sometimes I think that that can be kind of a hotspot.

20:20

For Yeah, we encourage frequent often conversation with the provider and the sooner you sort of begin exercising that muscle of asking questions of your provider and seeing them as like a co pilot or a team member versus the one in charge because you the birthing person or the one in charge, then it's easier. It's like we're on the same I want to be on a team and as a trusted team member with a lot of experience and education, who you trust. Like, I'm going to ask some questions of this person. It's like a conversation, right? And if they don't receive that, well, I would consider that a red flag, right? Like for that provider, they're not open to you asking questions about the things that you might encounter in your birth and they're not thinking about how that might look in the bursary. That's not what you want. And so that's why we say practice, how during pregnancy before you're in the space because it'll be a lot easier now and maybe you realize like, this is not the one for me, and you end up having an opportunity to change providers. So ask the hard questions, I think asking how they support unmedicated birth. If you even if you know you want an epidural there's still going to be a point under Labor where you're laboring without medication. So like how do they support physiological birth, medicated or unmedicated? And like what things do you do or offer or suggest or, you know, what positions are you comfortable with but with me pushing in with an epidural and without an epidural? Like and if they stay on your back and in the bad and that's it? Yeah. Red flag right? Is there like any position you want

22:03

to if you're like, so do you you know, support having a doula in there and if they're like, yes, so you know, they know that that's like a red flag sign as well. And we even I don't think it was in. I can't remember we've recorded a few episodes. We talked about that. And this would have not been talking about like hands on with birth, and baby turning and all the things and like, are we fooling or we did talk about that another one. Knowing where they're at with that, too, like Yeah, you know,

22:37

are you doing hands on delivery? Are you like pulling the baby's head out? Or are you letting the baby turn on its own and come out on its own and maybe supporting my perineum? And that's it or hands off all together? Like? That's a great question.

22:50

I got sidebar with with that with the question. So but yeah, well, no. And

22:54

how long Willie? I mean, asking about all the different stages of labor and how they support I mean, that's an episode on its own, and I'm sure we maybe have one where we'd like questions to ask provider. But in regards to epidurals and laboring, medicated and unmedicated, this is important this comes up. Most people like there are lots of topics around birth but a lot of people worry about pain, pain management epidurals and provider support through that so I understand that this is probably a topic that you care about. Take it seriously ask these questions, do the research. Check in with yourself and choose what works for you and then be flexible? Because you never know what might come up. I say epidurals are great tools when used judiciously, not willy nilly. And without

23:50

some not in the everybody gets one at that point. It's the same.

23:55

They're not perfect for everybody. Not everybody wants or needs them. They're not necessarily good. For but when you see them as as a tool that can be used judiciously and can have benefit and becomes less scary. I'm just not in the camp of painting intervention, all interventions is bad. I do think there are certain system issues with like cascade of interventions and interfering with the normal physiological birth process. 100% I just don't think any one intervention is just there's not like a clear like, yes, no, it's causes

24:28

this specific asset Yeah, no, no, and that's why well, that's why I wanted to kind of have that conversation. They don't really go into epidurals and not necessarily like the bad rap that they have, but a better understanding of it. So

24:43

that was understanding all the components of birth, and then in a meaningful way, and that's our goal here. Okay,

24:51

so hopefully you learned lots of information in the show today. So again, thank you so much for listening. We will have ratings and reviews on whatever platform you use to listen to the podcast and definitely check out some of our episodes because we have quite a few episodes out there. Just super exciting though. Again, new episodes drop every Wednesday, so stay tuned next week for another episode.