The MamasteFit Podcast Episode 89 – Everything You Need to Know About Epidurals!

[00:00:00] Gina: Welcome to the MamasteFit Podcast. In this episode, we’re going to talk all about what if you do want pain relief for your labor, and what can you do before you get an epidural, during your epidural procedure, and then afterwards to continue to have a smooth labor process.

[00:01:05] Gina: So if you are wanting pain relief, which is a totally valid path that many people want to take.

[00:01:11] Roxanne: 70 percent of people.

[00:01:13] Gina: It’s nice. The epidural nap is pretty bomb. It is pretty nice. There are some benefits to getting an epidural, such as one, you don’t feel pain- which I think is a huge benefit for a lot of folks. It can help you relax. It can help you rest if you’ve been laboring for a long time. So for me, during my first birth, it helped me rest and calm down, which was really helpful for me. For some of my clients, after they get an epidural and they’ve been stuck at a certain dilation for a long period of time, all of a sudden they’re like 10 centimeters because they finally were able to relax with their contractions. Some folks find that they prefer to feel more in control of the experience by being a little bit calmer with it, by being more aware. And so there’s lots of reasons that folks want an epidural, but most of the time it’s because they want the pain relief, which I think is a totally valid thing.

[00:02:00] Gina: However, an epidural, some folks believe, may interfere with the laboring process and maybe it increases your risk of C section or increases your risk of other interventions. And so sometimes folks get scared of getting an epidural as well.

[00:02:12] Gina: And so we’re going to talk about why are some reasons that folks get an epidural and what can you do to help you before you get one, because you will feel one contraction.

[00:02:21] Roxanne: You have to feel at least one.

[00:02:22] Gina: You will likely feel something before you get an epidural. And then how can we continue to support our labor process after we get an epidural as well.

[00:02:31] Gina: So first, Roxanne, what is an epidural?

[00:02:34] Roxanne: So I will say I’m not an anesthesiologist or nurse anesthetist, so I can’t give you all like the intricacies of like epidural placement and all of that. Just pretty basic though, it is a regional anesthetic where it numbs you from like about belly button down. So your legs are numb where you’re not feeling pain, but, you should still feel some pressure. So the pain sensation is numbed, but the pressure sensation is usually still felt.

[00:03:02] Roxanne: We do have a podcast episode with Puja who is an anesthesiologist all on, like, all the different pain relief options during labor, and that’s episode 20 if you want to check that out for more in depth information on an epidural.

[00:03:15] Gina: The epidurals that I usually find to be like the “good” epidurals are ones that people can still move around in but they don’t feel any pain. So it’s like this really nice medium between the pain relief but still feeling pressure sensations and the capability to move. So sometimes what I’ll do with some of my clients if they feel like they’re just not able to move at all is we’ll talk with the nurse or we’ll talk with the anesthesia about, “Can we change the dosage of this so it’s a little bit lower to find that perfect spot for them?” Or if they’re still feeling pain, can we talk with anesthesia to get some more pain medication? Because if you got an epidural for pain relief, you should get pain relief from it.

[00:03:53] Roxanne: Yeah, and that’s the one thing, with epidurals, a lot of people go into it expecting to feel absolutely nothing to include pressure. And that’s fine, if that’s what you’re wanting. But it is important to have some expectation management that like you might feel some sensations still. Some people will think that the pressure sensation in their butt or vagina is pain because it’s a weird sensation just all around. But that is an expected thing that we can’t always take away.

[00:04:22] Roxanne: There are different types of medications that kind of work differently. So there’s, most of the time, it’s like a numbing agent that’s put into the epidural and it’s the most commonly used one is like ropivacaine. But it’s similar to like lidocaine where it’s just like numbing the body. But sometimes they can add in other narcotics such as fentanyl to that epidural medication and that like just intensifies the pain relief. So sometimes I’ve found that people who have just like ropivacaine only in their epidurals are more likely to still have that pressure sensation and be able to move, than people who have the additional narcotics in that epidural.

[00:05:02] Roxanne: But again, everybody’s body’s different. We all respond to medication differently. So some people just need that additional medication. And it’s also dependent on how readily available is anesthesia to be able to adjust the dosage? If there’s only one anesthesia for the entire hospital that you’re at, they’re not going to be able to come and adjust the dosage as easily if you all of a sudden start feeling a lot of pain as they’re adjusting it. Whereas if it’s just one anesthesia for all of just Labor and Delivery, they’re more likely to be able to adjust and titrate that dosage a little bit easier to get you at the pain level that you’re wanting, as well as, still maybe able to move.

[00:05:39] Roxanne: So it’s also, hospital dependent. The one hospital where it is just one anesthesia for the entire hospital, they’re less likely to want to adjust the dosage because they don’t want you to call them 30 minutes later and be like, “Now she’s experiencing a lot of pain,” because, they’re busy, they don’t have time to do that because there’s just one of them. Whereas the hospitals that there was anesthesia for Labor and Delivery were more likely and willing to do that, and they would also come in and give extra dosages if it started like breaking through with pain.

[00:06:08] Roxanne: Most epidurals will have the little button, the boost button where if you do start experiencing pain, you can press this button and it gives you like an additional boost of medicine. There’s only so much, so many boosts that you can get in a time period, so you’re not gonna, overdose on the pain relief. but that is a nice option if anesthesia is not available, and you are trying to figure out a nice dosage amount to be able to, wait until they can get to you to adjust, it.

[00:06:37] Roxanne: But it is really nice when you can feel some sort of sensations. And I find that it’s nice at first to be able to get a lot of rest, especially if you’ve been laboring for a really long time, where you feel nothing, because then you can actually sleep because you’re, like, you don’t feel even the pressure sensations and you can get, a solid nap. Whereas if you’re still feeling those pressure sensations, usually people will wake up and be like, “Oh, what’s that?” And then they’ll go back to sleep. And so the rest is just more intermittent and broken up, versus the first two hours after an epidural usually it’s stronger and they can get a good, solid nap. And then hopefully after that, that initial bolus that they give you, like the boost at the beginning, it wears off and then they’re able to feel that sensation again. So that helps us to labor and move around, and especially with pushing.

[00:07:28] Gina: So let’s talk about what questions people should be asking if they are planning to get an epidural.

[00:07:35] Gina: What should they know about their birth location? I think the first one is where is anesthesia?

[00:07:39] Roxanne: Yes.

[00:07:39] Gina: And where are they assigned? Are they assigned to the whole hospital versus just the labor floor? Because that’s going to determine how quickly you can get an epidural, how fast they probably are at doing epidurals, how likely they can come and help support you after giving one.

[00:07:53] Gina: So I think knowing like where anesthesia is…

[00:07:56] Roxanne: Is super important.

[00:07:57] Gina: Is really important, especially if you’re wanting an epidural. Because we have some hospitals here where there’s just one for the whole hospital, and then we have some hospitals here that it’s one for just Labor and Delivery, and so those ones are much faster, and like you said, they can help to fine tune it a little bit more. And those ones tend to be very good, and not that the ones that are the whole hospital are not good at them, but they tend to be very quick with it, and I also find they’re a little bit more respectful when somebody is laboring and getting an epidural, that they are like more mindful that they are having a contraction and it’s painful for them, as opposed to somebody who’s typically doing epidurals, but somebody who is not in labor, they are, I find, to be a little bit less patient and a little bit more, abrupt and aggressive with it. But I’ve also seen anesthesiologists that were still very on the aggressive side and all they do is Labor and Delivery.

[00:08:48] Roxanne: It’s just person dependent, for sure.

[00:08:50] Gina: But I do think that’s a good question to know because it helps with the planning of like, when should I get to the hospital when I’m in labor if I do want an epidural? Because I will say, the saddest people are the ones who really wanted an epidural and their baby was falling out of their bodies.

[00:09:05] Roxanne: And they could not get one. Yeah.

[00:09:07] Roxanne: There is a third option with anesthesia. So like where they’re assigned and like where are they located? They’re in the hospital for these first two options, like either for the entire hospital or just Labor and Delivery, but they’re always in the hospital at any given time. There’s a third option where they’re at home, because maybe they’re just not used a lot in the hospital. So that person is at home, and they’re just on call, and they have to come to the hospital when you want one. And they, most hospitals, they can live within 30 minutes. So they have to be able to get there within 30 minutes. So I supported a birth where the anesthesiologist was not in the hospital, they were 30 minutes away. And when she was like, “I would like an epidural,” they’re like, “We can call them…” and they walked in as she was pushing. So she did not get the epidural, which granted like she didn’t want it anyway, but they did not arrive in time because it took them too long and I’ve heard that story probably more often where the anesthesiologist wasn’t in the house and it just took them too long to get there because they don’t want to call the anesthesiologist and then they’re like just waiting there for you to get to the point where you want an epidural. They have to wait until you’re like, “I would like the epidural right now,” and then call an anesthesiologist, and then they arrive, and then a lot of them will not make it.

[00:10:19] Gina: So this is important to note that you will not, probably, get an epidural the moment that you say that you want one. There will probably be some lag time. And this can vary from hospital to hospital on what kind of the pre workup is before you can get an epidural.

[00:10:34] Gina: So some hospitals I’ve seen, you have to get a whole bag of fluid before you can get an epidural, and some will give it to you while you’re getting fluid. So let’s talk about, what are the prerequisites for an epidural that may vary from place to place.

[00:10:47] Roxanne: Yeah. So let’s give two situations. One, you arrive to the hospital in labor, and you’re like, “I would like my epidural right now.” If you’re not yet admitted to the hospital, there’s some prerequisites that have to occur before you can get your epidural.

[00:11:01] Roxanne: One, you have to get admitted to the hospital. They have to do the paperwork to like, admit you into this system. And as well, place an IV. An IV is important for an epidural. If you’re not getting an epidural, that’s a whole other story, but if you’re wanting an epidural, you have to have IV access. And that can take some time to get that placed, depending on what your veins are doing. And then they also draw labs. One of the most important labs that most anesthesiologists care about is the platelet levels. So platelets are like the foundation of clots, so you need platelets to be able to clot. And if your platelets are too low, which can occur during pregnancy, if they’re too low, this can prevent clots from forming, which ideally is not great. Mostly though, if you have that epidural in place when they go to remove it, if your platelets are too low, that place that it was could not clot off and then you’re just bleeding into this epidural space. Still super rare, but this is a possible complication, and then nobody wants you to bleed into a space in front of your spine and get more pressure onto your spine. So platelets is like the one thing that they care about, but that is dependent on the lab, on how quickly that results will come back.

[00:12:10] Roxanne: So when they draw that in that lab, it’s a CBC complete blood count where platelets are involved, can take between 15 minutes if Lab is like super quick, up to 90 minutes if they’re really busy to get that lab back. Some anesthesiologists will be like, “Let me look at her previous lab results. Maybe she’s had one recently and that’s fine, and I’ll still give her an epidural based off of those labs.” Some anesthesiologists are more risk adverse, so they’re like, “No, I will not give it to her unless I know her platelets are above between 100, or 80,” again, anesthesiologists dependent on which one they prefer. Research doesn’t really, state, what is the number that’s, ideal.

[00:12:52] Roxanne: Once all of that comes back, then they’ll I’ll start giving you a fluid bolus because that’s when they’ll call an anesthesiologist. The research on whether or not to get a fluid bolus prior to the epidural or during the epidural, again, it’s like newer research, so it depends again on the anesthesiologist and the hospital policy. But the reason that we give fluids during an epidural is because a very common side effect of an epidural is low blood pressure. So your blood pressure can drop because it causes your blood vessels to relax. And if you don’t have enough blood amount, this could cause that blood pressure to drop because the blood vessels are larger. We don’t like it when our blood pressures drop. This causes, very weird sensations with our body, where we feel lightheaded, dizzy, nauseous, is probably the most common symptom that people will report. But our babies are reliant on our blood pressure to get their oxygen and nutrients through the placenta. Our blood pressure is very important for that. So if our blood pressure is dropping, not only do we not feel great, but our baby is not getting the same nutrients and oxygen, so then they don’t respond well to that. So that is why, the biggest thing is if we can get those fluids in. Again, hospital dependent.

[00:14:00] Roxanne: So this is a good question to ask during prenatal visits. Do you give the fluids before, or can you give them during the epidural placement? That kind of helps with the timeline because if it’s before, you have to wait usually like 30 minutes to get that fluid, but if it’s during, you don’t have to wait for that.

[00:14:16] Gina: And sometimes there’s a little bit of a delay too if you have to get the fluids before, because the nurse is not standing there staring at the bag, waiting for it to be done, and then calling anesthesia. She or he may be doing something else, and then they’re getting alerted that it’s empty and then they’ll come, they’ll check it, and then… So depending on if you have to get it before or during, there can be even more of a little bit of a delay as well, because they’re gonna go do other things during that time.

[00:14:42] Roxanne: Yeah. I usually would call, and I don’t know if this is again, hospital dependent, but I would call when someone wanted an epidural, I would start the bag of fluid and then call anesthesia to be like, “Hey, she wants an epidural, I just started the fluid.” So that they knew, “Oh, I’ve got some time to get there, but, I should start figuring out to get to this room because her fluid’s started.” And then I don’t have to wait until that bag of fluid is gone, and then wait for them to show up. Because then the benefit of the fluid bolus has kind of like dissipated, usually within the first couple minutes afterwards, and then, their blood pressure could still tank after an epidural. So I usually would call anesthesia, that was just, my trick, when I would start a fluid bolus. And sometimes, again, I would give them the choice of whether or not to come quicker if they preferred to do it while the fluid bolus is going in, or if they wanted to wait till after.

[00:15:36] Gina: But it’s still a good question to ask for expectation management of, “When, if I ask for an epidural, when will somebody give it to me?”

[00:15:44] Gina: So knowing like what are the prereqs? So you need labs, you need to know what your platelets are, and then the fluids. Do you need to have all the fluids in and then you can get it, or can you get it during the fluids?

[00:15:56] Gina: Things that I found to be helpful when you are getting an epidural is, one, to know what kind of support are you allowed to have. In some hospitals, you can’t have anybody in there. But the nurse and the anesthesiologist. In some hospitals, you can have your partner there, too. In some hospitals, you can have your partner and your doula there. So it really depends. And that is also like a good thing to know for expectation management, because you don’t want to suddenly be in this place of potentially panic, getting an epidural and now you’re by yourself, and you have to get it by your, like, all by yourself. And so that could be like another really good question to ask is, who can support me when I get an epidural? Is it just my partner? Is it nobody? Is it my partner and my doula? And it can vary. Sometimes, I’ve been in hospitals where it’s supposed to be just the partner, but if I hide quietly in a corner and I don’t say anything, anesthesia doesn’t ask me to leave. Sometimes anesthesia will still ask me to leave, so it just varies as well.

[00:16:50] Roxanne: And the reason behind it is usually safety. Obviously your spine is open, so it’s an infection thing, the more people that are in there, the higher increased risk that there’s potentially, germs in the air that could affect the placement.

[00:17:06] Roxanne: But it’s also, very commonly, people get a little lightheaded.

[00:17:11] Gina: Watching.

[00:17:12] Roxanne: Watching. And it’s funny because people will be like, “Oh, I see blood all the time,” but it’s different when it’s your loved one. Like doulas, I’ve not seen it, because obviously, you probably see like epidurals. I’ve not seen a doula pass out. I’ve seen nursing students and med students pass out

during epidural placements when they watch it. But I’ve seen partners pass out who are like, medics or paramedics but when it’s like your loved one who’s like being like, “Oh, this is a weird sensation,” and then they see the needle, they’re just like out.

[00:17:43] Gina: So let’s talk about the administration of it. So obviously we are not anesthesiologists.

[00:17:47] Roxanne: No.

[00:17:47] Gina: Like nurse anesthetist…. I’m struggling with words today.

[00:17:51] Roxanne: Yeah, like anesthesia, so you got all the prereqs, now anesthesia has arrived. I am ready to give you your epidural. What has to happen now? They have to consent you. They have to go through all the risks and benefits of an epidural to tell you, “Hey, just so you know, these are things that could happen.”

[00:18:08] Gina: I will sign anything right now. Just give it to me.

[00:18:11] Roxanne: That whole process, I think, is so wild because someone is like literally in pain, they’re like, “I don’t care what you tell me, I’m processing nothing that you’re saying to me, just give me this epidural.”

[00:18:20] Gina: I have seen anesthesia consent way before. So like someone came into triage or they’re getting an induction and they’re not quite at that point yet where they want one. I’ve seen anesthesia come and consent them prior cause they knew that it was their plan to get one. I see, during an epidural, when they show up in a really big labor or they change their mind during labor, and they’re like, “Just do it, I don’t care!”

[00:18:44] Roxanne: I have seen some hospitals will do like an epidural class that like, if you want an epidural, you have to go to this class. And this is where they go over like epidural placement and like the risks and benefits of an epidural and like what happens and stuff, so you’re not in labor at all, feeling zero pain, and you’re able to retain that information a lot more and be able to make more of an informed decision. If your hospital has that, even if you’re not wanting an epidural, it could be really great to go, because, yeah, again, if you change your mind, you’re going to process zero of the risks and benefits of an epidural.

[00:19:17] Gina: And it can also help motivate you if you are not wanting an epidural, knowing what the risks and benefits are can sometimes be a motivating thing for you as well. “Oh, those risks, I don’t really want to partake in.” Or you might be like, “I don’t care. I will take it.” So I think just having information from the experts can be really beneficial as well.

[00:19:36] Roxanne: But if you’re not in any of those situations, usually anesthesia will at least try to go over somewhat of the consents of the patient. Hopefully, you have already signed the consent and they’re asking you at that moment to also sign it. Sometimes the nurses will at least get you to sign the consent and then the anesthesiologist will then come and sign it to say that they did consent you, so you’re not having to do that step.

[00:19:55] Roxanne: But that is usually number one, they introduce themselves hopefully, consent you, and then you have to be in the position. So you have to assume the epidural position.

[00:20:06] Roxanne: Some people will do it laying on the side, but majority you have to sit on the side of the bed. And you have to make this curling shape, it’s like cat curls around the baby.

[00:20:16] Gina: Like a shrimp.

[00:20:16] Roxanne: Like a little shrimp. Everybody uses like different words, cats or shrimp. When you’re curling around your belly, you’re not just curling your upper body, you’re mostly curling from that lower spine because that is opening up the spinal processes to be able to get to that epidural space a little bit more. That position you have to hold for the entire process, which is very uncomfortable.

[00:20:39] Gina: So during pregnancy, we can also do exercises to help prepare for an epidural as well. And so lower spine mobility is going to be huge. So being able to find that really rounded position in the lower back, releasing hip flexors and lats so that you can find that position.

[00:20:55] Gina: And those are things that we include in the MamasteFit Birth Prep Circuit because finding a rounded position is harder to find during pregnancy, and is also really important to helping baby move through the pevis. And so you can do our birth prep circuit, even if you are planning to get an epidural, because it’s going to help you to find that rounded position while getting an epidural as well.

[00:21:14] Gina: Let’s take a break from this week’s episode to hear about our podcast sponsor, Needed. Needed is a nutrition company that specializes in optimizing nourishment for the perinatal timeframe. It is a brand that Rox and I have personally used during our pregnancies, our labors, our postpartums, we’ve got everyone in our family using it now. And so they’re a brand that we truly trust and highly recommend. And one of my favorite products for them is their collagen.

[00:21:37] Roxanne: And the collagen protein is something that I take literally every day, sometimes multiple times a day, depending on my energy levels. But our protein needs during pregnancy and postpartum are increased because we’re doing a lot of things during pregnancy and postpartum, and sometimes it’s really hard to get that from real food. Protein is really hard to get for a lot of us. So collagen is a really easy way to be able to increase our protein intake without having to eat a steak or something. We really like their collagen protein because it’s third party tested as well as they’re really intentional on their ingredients, so the ingredient that they chose is something that is readily absorbed in our body. And I really like that it dissolves really easily in everything that I put it in. It doesn’t become clumpy, and it doesn’t add extra flavors, which other collagens that I’ve tried do both of those things, and I don’t like it.

[00:22:27] Gina: I like to add it to my oatmeal. It makes it super easy to mix into my oatmeals in the mornings, and that’s how I’ve been getting that extra protein in during my breakfast.

[00:22:35] Roxanne: And I really like adding it to my morning cup of coffee. And if you want to try it out, you can go to thisisneeded.com and use code MAMASTEPOD 20 percent off your first order.

[00:22:44] Roxanne: So once anesthesia comes in, you assume the position, whether your partner is there or not, usually the partner will either help support you in that position or the nurse will be the one supporting you. I find holding the pillow to then be able to lean on is a little bit easier and a little bit more comfortable for people. Also, with your legs, if you can sit crisscross applesauce, if you can sit in this comfortably, it’s easier to be able to open up that lower spine in this position, rather than a lot of people like dangling their legs like this, it’s harder for them to find that open space. But again, not everybody can sit crisscross applesauce, so, practice, maybe, during pregnancy. That would be a thing. I find those two positions easier for anesthesia to be able to then place the epidural.

[00:23:27] Roxanne: The actual placement is like super quick, usually.

[00:23:31] Gina: So the needle looks gigantic, which is usually what a lot of folks have a lot of anxiety about, and it’s sometimes a motivator to not get an epidural, it’s like, “That needle is so big!”

[00:23:41] Roxanne: It’s really not that large.

[00:23:42] Gina: There is a local anesthetic applied, so you don’t, you feel pressure, but you don’t feel like a needle into your spine.

[00:23:50] Gina: So I had an epidural during my first. The Lidocaine that they gave me just was like a little burning sensation, almost like a bee sting in my back, and then I just felt like pressure, but I didn’t feel pain from it.

[00:24:04] Roxanne: You should not feel pain.

[00:24:06] Gina: But I was like terrified because I was like, “If I move, I will be paralyzed.” Anesthesia just like talks you through it. Like it’s not, it’s just like lots of, it’s like a pressure sensation, but it’s not painful- just to help quell some anxiety and like worries about it.

[00:24:21] Gina: But if you do feel a lot of anxiety about it, have them talk you through it, as you go, at the same time. Because sometimes that’s comforting to know, what to expect. Because you know when you’re, like, waiting for something and you start clenching, because you’re like, “Are you going to do it? Are you going to do it?!” sometimes that can be, like, a really helpful technique.

[00:24:38] Roxanne: I think there’s also a lot of fear on Instagram right now and TikTok of epidural needles. And they’re, like, showing these needles that are, like, a freaking mile long, and they’re like, “This is an epidural needle!” No, that’s not. That’s not an epidural needle. That, that is, my entire body depth. That is not the needle that they are using to get to your spine. I promise you. It’s probably, like, that long.

[00:25:06] Gina: But the needle does not stay in your back.

[00:25:09] Roxanne: The width of it is like larger, that’s probably what gets most people, more than the depth. It’s like a… I hate this word, but, girthy.

[00:25:17] Gina: It’s the diameter.

[00:25:19] Roxanne: The diameter of the needle is larger than if they’re putting your IV in because they have to be able to then put the catheter through that needle.

[00:25:30] Roxanne: So the longest portion, honestly, of epidural placements is, like, all of the prep. Because they have to, prep your back with anesthetic, and then they put this drape on it, and then they do the lidocaine, and then while the lidocaine is doing its magic so you don’t feel pain, then they’re, like, prepping all of their stuff so that once the lidocaine has set, then they’re able to put the needle in, find the epidural space, because it is a blind procedure, and that’s important to know that they don’t have an X ray, and are finding this spot with an X ray, it’s just all by feel, which is like kind of magic in a way. But they find the spot, they insert the catheter. As soon as they insert the catheter, they take the needle out, and it’s just this like fishing wire type catheter in your back. That’s when they’ll then test the location, because we want to make sure it’s in the epidural space and not in a blood vessel, which is unideal to then insert, the medication is not good in your blood circulation. No one should be inserting lidocaine into our blood circulation. It’s just not great for us.

[00:26:29] Roxanne: Once they place that, they insert what’s called a test dose. The test dose is to tell us that it is in a good spot and not in your blood vessels, in circulation. Once they enter the test dose, we ask you, like, “How do you feel? Is your butt numb? Are you feeling metallic taste in your mouth? Any ringing in your ears?” Does your heart rate jump up or like blood pressure tank? These are things that we’re watching for after that test dose. It takes a couple seconds. If you say, “I feel fine,” great, it’s probably in the right location.

[00:26:57] Roxanne: After that, then they put the multiple pieces of tape because we don’t want it to move. The amount of tape that they put on your back after an epidural! We say with every baby, in an epidural, you get a little free back wax because it’s a lot of tape. But again, you want the tape because you don’t want it to move.

[00:27:16] Roxanne: After that, then they’ll give you like a bolus of medication. But from that bolus, it can take like 15 to 30 minutes for it to reach its peak relief. The bolus can sometimes start to feel like some tingling, like your legs are going numb within five minutes depending on the medication that they use, but for most people it’s like 15, 30 minutes later is when you start to feel relief.

[00:27:37] Roxanne: During that entire period we’re monitoring your blood pressure a lot to make sure that blood pressure is not, again, tanking after your blood vessels are starting to dilate and relax a little bit. And we’re like doing this for 30 minutes after that epidural until it reaches that peak.

[00:27:52] Roxanne: During this time, though, we’re also monitoring how well the pain relief is happening. Is it equal? Do you still feel it in certain spots, but, your whole leg is numb, but maybe right at your right hip, you’re still feeling a lot of pain, but, the rest of that side is numb. Or maybe you’re still feeling your left side, but not really your right side, so that’s telling us that maybe it’s a little positional. It works by gravity, so we’re going to put you on the sides that maybe it’s less effective on, hopefully, to make it more even. It, again, works by gravity, so you can’t just stay on one side the entire time after you get the epidural, so we’re hopefully still flip flopping you so that you have equal relief. We try to avoid placing you flat on your back with an epidural, though, because that does increase the pressure that’s on the great vessels of your spine, so that decreasing blood flow to our baby also makes them really mad. Hopefully we’re still flip flopping you after that epidural is placed.

[00:28:47] Roxanne: After you’re fully numb, this is when it, again, hospital dependent, but most hospitals will do some sort of Foley catheter into your bladder. So this is a tube that goes into your bladder that just sits there to empty the bladder because a full bladder could impede labor- because if a full bladder is there, it’s not going to let your baby move through your pelvis because it’s like an obstruction.

[00:29:07] Gina: So if someone does not get the Foley catheter, will they just pee themselves? Because I think that’s like a misconception as well.

[00:29:13] Roxanne: Yeah, no, you won’t pee. Your bladder will just continue to fill because you have to like control the sphincter at the urethra, is you like control it. For most of us, you have to decide, I’m gonna relax this sphincter and I’m going to pee. So your bladder will just continue to fill most of the time. It might be, like, leaking a little bit if it gets overly full, but for most people, you will not just pee yourself if you don’t get the Foley catheter, you do have to have something that empties the bladder.

[00:29:42] Gina: I will say, though, you might fart unknowingly.

[00:29:46] Gina: That’s like the epidural farts. I do, I… So anything with the butt, we have a whole episode on butt stuff, anything with the butt is like embarrassing as just a person in general. And so there is this thing called epidural farts because you’re so relaxed that your body will just let out the air. It can be embarrassing, but it’s like a good sign that you’re relaxed.

[00:30:11] Roxanne: Yeah, that’s good. But also it’s like during labor, there’s a lot of fluids. Especially if you’re also ruptured, but vaginal discharge increases during pregnancy at the end, as well as if there’s fluid, and farts are louder when there’s moisture around, so if there’s moisture there, they’re even louder.

[00:30:29] Gina: So if you didn’t know about epidural farts, just be mentally prepared.

[00:30:34] Roxanne: Partners, it’s yours, you did it.

[00:30:36] Gina: You heard nothing. There’s a frog in the room. Someone stepped on it.

[00:30:42] Roxanne: Yeah.

[00:30:42] Gina: But I think that’s something that folks get, I’m, like, shockingly embarrassed about. They’re like, “Oh, my God, what was that?” That was an epidural fart. I’m sorry.

[00:30:50] Roxanne: But epidurals, they can be really great. After that initial 30 minutes recovery, we still will monitor the blood pressure pretty closely, because sometimes you can not have any issues immediately after, but like a couple hours later, maybe you relax a little bit more, and then your blood pressure can tank.

[00:31:06] Roxanne: And so something that can happen from your epidural is your baby’s heart rate could start showing signs that they’re no longer tolerating labor. They’re showing signs that they’re stressed with their heart rate, where their heart rate is decreasing after contractions have started. And this is due to usually something with the placenta. So the placenta is not being perfused enough from a low blood pressure. So if we see that we usually will assess the blood pressure as well as hopefully give you medication to increase it because sometimes baby’s heart rate will start to display before your blood pressure actually has decreased, which is like babies are so cool like that.

[00:31:43] Roxanne: But this is not like an epidural can cause a C section. There is no research that supports an epidural can cause a C section, but if there is a reason for a C-section after getting epidural, most commonly I’ve seen it is due to baby no longer tolerating labor after getting that epidural.

[00:32:00] Gina: So a big concern that I’ll see with why someone shouldn’t get an epidural is it’s gonna increase your risk of a C-section. And so let’s talk about some reasons why after you get an epidural, it maybe could lead to a C-section and what we can do to avoid that.

[00:32:15] Gina: So the studies that I have seen essentially said if you get an epidural and you essentially just lay there and you don’t move, your baby can sometimes get into a funky position and then it makes it harder for them to pass through the pelvis. And so essentially the way to remedy this is to continue to move even with an epidural. And there’s two main tools that we have to help us with movement after an epidural. One, the peanut ball, literally the only use that I have ever found for a peanut ball is labor. And so we can use the peanut ball to help position the hips in different positions to create more space. So we can put it between the knees to help create more space in the top of the pelvis, so we’re making more external rotation at the top. We can put it underneath one knee for more of the asymmetrical positioning, underneath one shin for that asymmetrical positioning, to help create space in the mid pelvis, this is going to help baby rotate. And then we can add some movement with like rocking and stuff in those asymmetrical positions. If you’re pushing and you want to rest in between pushes and create space in the outlet, we can put the peanut ball between the ankles for more of that internal hip rotation. So we could use the peanut ball to create different types of space within the pelvis and to aid in movement. And especially in the mid pelvis openers, your partner can rock your leg back and forth when it’s on that peanut ball.

[00:33:30] Gina: And the next tool we can use is the labor bed. It is a transformer. It can go into so many different positions, like a seat.

[00:33:37] Roxanne: It’s such a great tool that’s often not used.

[00:33:41] Gina: They have different props that attach to it. So there’s a lot of different positions that you can get into with the labor bed. And there’s lots of buttons on it, so if you’re like, “What do all of these buttons use? Or how do they work?” ask your nurse. Be like, “Hey, can you show us how to transform this bed?”

[00:33:56] Gina: And I also find that nurses will do a really good job with helping you get into positions as well. Whether or not the positions they’re putting you into is like creating space where baby’s at is a whole nother conversation based on what kind of training, additional training that they’ve had. But in general, they’ll bring the peanut ball, they’ll put it between your legs, and they might reposition the bed a little bit. So depending on how proactive they are with it, can be like a good thing to check out in the moment, or you can just ask them, “Hey, we want to get into a seated position. We want to get into this position.”

[00:34:29] Gina: In our online childbirth education course, we have tons of laboring positions to include epidural ones. And so what I usually find when you are on the more numb side and having a harder time getting, or knowing how to explain a position to somebody, showing them a picture is really easy. “I would like to get into this position,” and then they can help you adjust the bed and things like that. Because you can absolutely still change positions, even with an epidural.

[00:34:54] Gina: Now, my one caveat is, if you want to get into a more upright position with an epidural, like a lunge, you want to lean on the back of the bed, you want to get into a supported squat, you want to get the birth ball on the bed and lean onto it on all fours, you can do that if you can get yourself in that position. So if your partner has to pick you up and put you into all fours, it’s probably not safe for you to be in. Cause you might be a little bit too numb. If you can get into an all fours position with fairly little assistance- like you might need a little bit, cause it does feel a little funky- it’s probably safe for you to be there because you still have kind of the movement integrity to maintain the position for a long time. And so that’s usually what I would recommend is if you can get into all fours with an epidural, it’s probably safe for you to be there. If you cannot, then maybe like a seated position where we use the bed to move you around to get you into an upright position can be more beneficial.

[00:35:50] Gina: And so you just got to play around with how strong is this epidural for me? And if you can’t move, maybe we need to look at the dosage. And then again, that depends on how available is anesthesia to come and help adjust the dosage so that you can get to a point that you could move.

[00:36:05] Roxanne: I will say, like Gina said, is the position that they put you in, is that going to be like the part of the pelvis that’s actually where the baby is, that’s opening? Motion is lotion. Any motion is better than no motion. So if they, maybe they put you in a lunge when your baby is still trying to engage, is it going to harm your labor? No. It’s still motion. It’s still opening the pelvis in different ways. it’s not going to totally ruin your labor if they don’t put you in the perfect position for where your baby is. But, there are things that we can do to maybe optimize the space that is available for a baby.

[00:36:36] Gina: And so again, in our childbirth education course, we do break down how to specifically open each pelvic level, what labor positions do that, how to know where your baby is within your pelvis.

[00:36:45] Gina: And so definitely check out the online course because we have videos that show you positions, how to know… we break down way more than we can within a podcast episode.

[00:36:54] Gina: The next part, after we get an epidural, we’ve been laboring, you’re taking your nap, you’re doing all your peanut ball and your bed movements, is pushing. And pushing with an epidural is different than pushing without any sort of pain medication. There’s different sensations that are happening, and it can vary from person to person depending on how strong your epidural is as well.

[00:37:15] Gina: So for me, during my first, I had a super strong epidural. I could not feel a thing. and it was really hard for me to connect my mind to my body because I could not feel. I couldn’t feel really like pressure or anything. And so it can be helpful to one, play around with the dosage again so that you can feel the pressure sensations because it’s really beneficial for pushing, to be able to feel when you’re having contraction and to feel that the baby is moving or that you feel like, “Okay, there’s more pressure now, I know that was a good push.” If you don’t have a weaker epidural, or one that’s not quite as strong, and you feel no pressure, a very dense epidural, and trying to adjust it is bringing you more pain, because I’ve also had that, where we played around with the dosage and now they feel contractions again, and then we give them more and then they feel nothing. And so it’s like, well, feel nothing. Like, we’ll help you. Cause you don’t want to get an epidural and still feel pain. Like it defeats the purpose of it at that point.

[00:38:15] Gina: And so different things that I found helpful for me when I had an epidural and that I find helpful for my clients that have epidurals when they’re pushing, is one, we’re going to probably spend a little bit of time reconnecting, like figuring out what sensations equal this output, or this outcome. And usually what I find is starting like on your back to start pushing to figure out the sensation I find to be the easiest because you’re, if you try to get into a funky position, one, your nurse or your provider may not be as familiar with that position, and they may not know how to give you feedback. Or two, you’re also in a funky position yourself, and you may be trying to figure it out. So I usually find just being flat on your back trying to figure out the pushing is usually the easiest place to start, but again, you’re an individual, you may have more pressure sensations where you feel it, and you can start however you want as well. But that’s my general recommendation is to start on your back.

[00:39:09] Gina: I find that the nurse giving you internal feedback to feel how well baby’s head moves with your push, and then give you feedback to be really helpful also. Where they can say, “Yes, you’re moving your baby.” Like, “That was a good push. Do that again.” And then it’s like, okay, that sensation is moving my baby. I will do that again. But that could take some time. That takes some time.

[00:39:30] Gina: And you can play around with whether or not you want to exhale or hold your breath. I usually find like when you’re trying to figure it all out, holding your breath is like one less, it’s one less thing to think about, is like also exhale and then push in this way. And after you get it and then adding in the exhaling if you want. But those are like the things that I find to be helpful to figure out what is happening. And then after baby is much lower and you’re starting to see a little bit of the head, a mirror is helpful because you can see the physical, “Oh, when I do that, I see more baby. I will do that again.” And so that gives you the visual feedback as well. So those are things that I have found as a doula to be helpful to figure out pushing with an epidural. So what have you found to be really helpful as a nurse?

[00:40:12] Roxanne: So for pushing with an epidural, if we have zero sensation, sometimes we’ll offer to turn down the epidural while we’re laboring down.

[00:40:21] Roxanne: So one of the things that you can do when pushing with an epidural, like once you’re 10 centimeters, that does not mean you need to start pushing at 10 centimeters. We can do something called laboring down, which is where we delay pushing for like up to an hour. And so then we would just put you in a certain position, again hopefully depending on where baby is within your pelvis, to allow your uterus to just push your baby down so that you have to do less work. After an hour, maybe two hours, depending on like maybe how busy it is, honestly, that’s when we’ll start pushing like more actively and hopefully your baby has moved down at this point, further in your pelvis so that, again, you have to do less work.

[00:40:58] Roxanne: After that, I normally will again start on the back to see maybe they just have the mechanics, right? And so we’ll do some like test pushes to see how well you push. After that, this is when I would start like offering some assistance on like internal feedback to see like where baby is doing as well as offer, usually, I’ll start with tug of war. Some people will start with the other things. I just go straight to tug of war because it’s the best way for them to, if they’re going to feel pressure with pushing, usually tug of war is it because it just helps them like engage all of the muscles right to be able to push the baby down.

[00:41:33] Roxanne: It’s more strenuous though compared to the other positions. Tug of war involves more muscles than just like holding your legs. I feel like people like engage their upper body a little bit more.

[00:41:44] Gina: What is tug of war?

[00:41:45] Roxanne: Oh good. Good question, Gina. So tug of war is where we have a sheet that you hold, it’s literally like you’re playing tug of war. So this is where they’re holding the sheet on one end and either a nurse or your partner is holding it on the other end, or hopefully, more likely, it’s around the squat bar attachment that can attach to your bed. And when you’re pushing, you’re pulling the sheet towards you to help engage your like upper body muscles, and increase the pressure downward- and like it creates a little bit more space for baby, hopefully.

[00:42:19] Gina: You can also attach it overhead on the bed. There are some points where you could touch it on the bed so you can pull down. And so what we’re really looking for is the elbows in type position to engage the lats, which is helping to open up the bottom of the pelvis.

[00:42:33] Gina: And so lat tension pulls the tailbone out a little bit more, which creates more space in the bottom of the pelvis, which is why the tug of wars can be beneficial while we’re pushing. So you can either pull from the bottom, where we’re keeping the elbows in, I’ve heard people say to chicken wing the arms, but I find that to not be, that doesn’t engage quite the right muscles. So keep the elbows in as you pull, or you can pull from overhead, which I find most folks actually prefer to pull from overhead.

[00:42:59] Roxanne: It’s just not as easy to implement.

[00:43:02] Gina: And we also have bed handles that you can pull up and you can grab onto those with the underhand grip. That would be like another technique to engage the lats.

[00:43:10] Roxanne: It’s just easier, I find, to do the tug of war because people have played tug of war as kids, and so you intuitively know the breathing strategy, where people know before they pull on this sheet to take a big deep breath in, and then bear down with it.

[00:43:28] Roxanne: That is, the tug of war, lat engagement, all of that is beneficial, but, people are intuitively, they know to, hold their breath and they can bear down in their perineum a little bit easier and push their baby down. I’ve just found that once that clicks, and especially as the baby comes further down into the pelvis, sometimes the epidural is not as dense in the lower portion of the pelvis, so that once that baby’s there, they’re like, “oh, now I feel pressure, and now I have that feedback,” once baby’s lower. If they can do that for three or four pushes and then they get that like feedback of like, “When I do this, this happens,” then we can switch to some of the other positions of being on our side, using the hand rails- which are really cool, they like just come up and you can just hold on to them. Because sometimes just having something to hold on to with our hands, because we want our legs to be relaxed, you’re not pushing with your legs. It’s really hard not to, because when you think about it, you’re just using all of your muscles, but like we want to try to keep our legs relaxed when we’re pushing. With an epidural, it’s a little bit easier, but if you still have some sensation, a lot of people will just start kicking people as they’re pushing, and, we would like to also not be kicked.

[00:44:39] Gina: Relax your leg!

[00:44:40] Gina: Other things that I have found helpful for, that initial part of pushing to, try to get the baby lower is to push in a supported squat in the bed, so with a squat bar attachment, or in a seated position, so we’re in that more upright position to help baby get lower and then transitioning. So like you were saying, get baby lower, we can feel more pressure, and then start trying these other positions as well.

[00:45:00] Roxanne: I think it’s important to know like when you’re pushing with an epidural, you don’t just have to push on your back the entire time. We do want you to still move. If you’ve been pushing for three, four contractions, nothing’s happening, you can reposition and try a different position, either on your side, maybe switch to the other side, try sitting up, trying the tug of war.

[00:45:17] Roxanne: We want to try to do different things because again, motion is still lotion even when we’re pushing. We want to be moving our pelvis because our baby is still like navigating that lower portion of the pelvis, hopefully the lower portion of the pelvis, to be able to come out and extend their head and be born.

[00:45:33] Roxanne: The pelvis still needs to like adjust and make room and by repositioning even when we’re still pushing can be really beneficial even with an epidural.

[00:45:42] Gina: I find every like 20 to 30 minutes switching to a different pushing position is usually a good goal, but like when we make it to a new position it’s usually one or two pushes like, how does this feel?

[00:45:52] Roxanne: Figuring it out.

[00:45:53] Gina: Does it feel good for you or do you want to go back to a different position? Because you might get into a position to be like, “I actually didn’t like this as much as I thought I would.”

[00:46:01] Gina: And so, let’s talk about one of the concerns that folks have, or we hear is, “I’m not allowed to not push on my back. My doctor told me I had to push on my back.” Usually I think they refer to like when the baby’s actually being born, being on your back. And so these are like good questions to ask at your prenatal appointments, “I would like to try a bunch of different positions when I push,” or, “I would like to be open to whatever positions seem to work for me. What is your viewpoint on it? How do you feel about it?”

[00:46:30] Roxanne: I will say another question that I think is important is, “When I’m pushing, where are you?”

[00:46:37] Gina: Oh yeah.

[00:46:38] Roxanne: Because I’m going to be honest, some hospitals, the provider, especially if it’s a midwife even, like they’re going to be there for a lot longer. If it’s a teaching hospital, the residents might be there longer for the pushing portion. But some hospitals, they’re going to show up as the baby’s crowning just to catch it and be like, “Good job, you did amazing!” Your nurse is going to be the one that’s doing most of it. So it is, important to ask, like, “Where are you when I’m pushing? Are you there the entire time?” Because then they could be like, “Yeah, you can push in whatever position,” Because they show up at the end, so it doesn’t really matter. They’re not there to tell you that you can push in other positions. It could be important in those cases when you do a tour, “Hey, I would like to push in different positions with an epidural. What do you as the nurses do during pushing?” Because that might be a bit more helpful for your planning process. If the nurses are like, “You push on your back,” then you know, “Oh, okay, I need to maybe have a doula or educate myself on all of the different pushing techniques.”

[00:47:35] Gina: Find a different hospital,

[00:47:37] Roxanne: Find a new hospital, honestly, but usually at that point, you might be like, ready to have a baby.

[00:47:42] Roxanne: But asking the hospital can be more beneficial of pushing techniques because again, your doctor might not be there. So again, they could say, “Yeah, you could push in whatever position you want, but when you deliver your baby, I prefer you on your back.” That, again, you could push for two hours. You’re not going to hopefully be on your back for that two hours. Because again, they’re going to show up the last maybe five minutes of that.

[00:48:05] Gina: So another person that you can ask about how does the hospital do it? Doulas. It doesn’t even have to be a doula you’ve hired, it can just be one that you asked a question to, usually.

[00:48:14] Gina: For me, I’m not about gatekeeping birth information and I just like word vomit on people. So if people ask me about local hospitals, even if they have no intention. to hire me, I tell them. “This is the general vibe there. Some nurses will let you do this, most won’t, or most will, some will,” and then just give them my general opinion on it.

[00:48:33] Gina: Other things that you can do to figure out or advocate for the pushing position that you want to be in is you can mention it at triage. You can mention it specifically to your nurse, “I would like to push in different positions, if possible.” And then when you are pushing, if you would like to not push on your back, it doesn’t feel good for you- you may find that being on your back is most comfortable for you, which is also fine, pushing on your back is not bad or evil by any means but- you should push in the position that you feel most comfortable in. And if it’s not on your back, then push somewhere else.

[00:49:05] Gina: And what I sometimes find is, someone will be in a position that they find to be most comfortable while they’re pushing, baby’s starting to crown, and then the provider walks in, and they’re like, “You have to get on your back.” Or, even before the provider comes in, depending on the vibe of the hospital, the nurse may start saying, “You need to get on your back, the doctor’s coming into the room.” And then the doctor comes in and they’re like, “I don’t actually care. They can be in whatever position.” But, so, if someone comes in and they tell you, you need to be on your back, and you do not want to be on your back, you feel comfortable where you’re at, what I will do as a doula, or something that a partner can do, is to ask you out loud, “Are you comfortable in this position?” and if you say, “Yes,” then your partner or your doula can say, “They’re comfortable. They would like to stay here.” And then that’s the end of the conversation, where if you are most comfortable in that position, regardless, like you should be allowed to stay there and they will figure out a way to support you.

[00:50:00] Gina: So I find that to be like a really easy way to like quickly advocate for yourself and to let everyone else in the room know I am comfortable in this position and you will not move me, is for someone to say, “Are you comfortable in this position?” And if you say yes, then you can stay there. You might be like, “I literally don’t care. Get this baby out of me.” And you might be like, “Yeah, I’ll go on my back. It’s fine.” So just, that’s like a helpful way to advocate in the moment that I find when it comes to pushing as well.

[00:50:26] Gina: The best pushing position is the one you choose. So if you choose to be on your back, that’s fine. If someone forces you on your back and you didn’t want to be there, that’s not fine. Nobody should put their hands on you. nobody should put their hands on you or force your legs into positions you don’t want them to be in.

[00:50:44] Gina: And yeah, pushing with an epidural can be challenging ’cause you have to figure out the sensation. So I think it could take half an hour to an hour usually to figure it out.

[00:50:55] Roxanne: To figure it out, yeah.

[00:50:56] Gina: And then we start getting creative with positions and moving around and changing.

[00:51:00] Roxanne: And it could take up to four hours.

[00:51:02] Gina: It can.

[00:51:02] Roxanne: With an epidural because again, that first hour is,

[00:51:04] Gina: Usually I would say two,

[00:51:05] Roxanne: figuring it out.

[00:51:06] Gina: two and a half hours is what I usually expect with an epidural, just ’cause it takes about an hour to figure it out.

[00:51:11] Roxanne: Hopefully it’s all shorter for everyone listening to this episode.

[00:51:14] Gina: And then it’s usually about an hour from there for like the baby to be born and all that.

[00:51:18] Roxanne: Especially first baby.

[00:51:19] Roxanne: I will say, we talked a little bit about the fear of an epidural with C section, it’s like, “if I get an epidural, I’m going to get a C section, or more likely to get a C section.”

[00:51:28] Roxanne: And the research is conflicting on if that is actually a risk. Most of it does not support that if you get an epidural, you’re more likely to get a C section, which, lots of people think that, they’re like shocked by that statistic that people who get epidural are not more likely to have a C section.

[00:51:45] Roxanne: But the statistic is, like actually proven, if you have an epidural, you’re more likely to have an operative vaginal delivery. So this is your provider used either forceps or a vacuum to help baby like get under that pubic bone and be born. That is actually proven by research that people who get an epidural are more likely to have that intervention in the pushing section compared to someone who does not have an epidural.

[00:52:07] Gina: So things that contribute towards operative vaginal delivery is maternal fatigue, so you’re getting tired, and when you have an epidural, you tend to push a little bit longer, which, it’s fatiguing.

[00:52:17] Roxanne: It’s very tiring.

[00:52:17] Gina: Pushing is very fatiguing, so that could be something that contributes towards it. And so this is where like exercising during your pregnancy could potentially be beneficial. Like trying to create more space within your pelvis while you’re pushing could be beneficial. Like learning breathing techniques during pregnancy can be beneficial to help decrease that risk as well.

[00:52:34] Roxanne: And eating.

[00:52:35] Gina: And eating during your labor.

[00:52:37] Roxanne: During labor. Eating and drinking during labor could also help because our body is full of muscles that need fuel, and if you are very tired and you haven’t eaten for 48 hours, that’s probably not going to be very helpful for your labor.

[00:52:49] Gina: So let’s recap. If you do want pain relief during your labor, which is a totally valid birth plan and birth path for a lot of people, like 70 percent of people in our country get an epidural.

[00:52:58] Roxanne: Yeah.

[00:52:59] Gina: It’s important to note that you will not get it immediately. There will be some sort of wait period when you’re like, “I would like pain relief, please.” There’s going to be some time before you get one.

[00:53:06] Roxanne: So having some coping skills for labor is helpful.

[00:53:09] Gina: Knowing, yes, knowing some comfort measures.

[00:53:11] Roxanne: You will experience at least one contraction.

[00:53:13] Gina: Yeah.

[00:53:13] Roxanne: At least one.

[00:53:14] Gina: Knowing some comfort measures is beneficial. So counterpressure, TENS, all of the different things is, it’s still helpful to know that stuff because you will probably experience at least one to… twenty contractions. Many contractions.

[00:53:29] Gina: During the epidural procedure, you want to find that big rounded position, and then knowing where is anesthesia? How many anesthesias are there? Who are they assigned to? Where is my partner going to be during the epidural procedure? Can be really helpful as well.

[00:53:43] Gina: And then knowing the things that may contribute towards increased risk of Cesarean birth with an epidural is lack of movement. So baby gets into a funky position and we’re not moving and they are not able to wiggle through the pelvis or get out of that funky position. This is where the peanut ball and using the labor bed and using the tools you’ve learned from us for different labor positions, your doula, your nurse, there’s resources out there to help you figure out movement can be really helpful because motion is lotion and that’s what’s going to help your baby wiggle and rock through your pelvis. And trying all sorts of different positions, playing around with your epidural dosage if you can to decrease so that you can move more, maybe increase if you’re feeling more pain so that you can relax more. But that’s really going to depend on: where is anesthesia? How readily are they able to support you?

[00:54:30] Gina: When it comes to pushing with an epidural you might not feel very much and so there’s going to be, it’s going to be a different sensation than if you were unmedicated, so it might take some time to reconnect mind and body, and so being patient with that process and using a bunch of different tools that are available to you. So maybe we’re doing tug of war to increase muscular activation, maybe your nurse is doing internal feedback and giving you feedback of, “I can see the baby is moving.” Sometimes me, as a doula, can give feedback, not internally, like I can see externally that your perineum pushes out. That was a good push. Your baby is probably moving with that because it’s pushing your perineum outwards. So sometimes there’s external cues that we can use as well. You can use a visual cue with a mirror.

[00:55:09] Gina: So there’s a little bit more tools involved with supporting an epidural birth, but it’s probably going to take a little bit longer because you gotta reconnect, like it just takes some time, but it is totally doable.

[00:55:20] Gina: So hopefully you found this helpful for you to know what is what when it comes to an epidural. If you want to learn more on like the science of it and like the specifics, episode 20 is our pain relief episode where we have Dr. Puja Shah. Who’s an anesthesiologist, and she explains the nitty gritty of epidurals in that episode.

[00:55:39] Gina: If you want to learn more about epidurals and pain relief and your birth options, plus laboring positions, things to do after you get an epidural, and those comfort measures, because you still need to know them, check out our online childbirth education course, because we break down all of that in our online course, whether you want an epidural birth, whether you want to go unmedicated, whether you’re planning a Cesarean birth, like we breaked out all that information in that online course, because we want you to feel empowered on this journey.

[00:56:05] Roxanne: And this episode is sponsored by Needed, a nutrition company focused on the perinatal timeframe that both Gina and I utilize and really love. And you can check them out at thisisneeded.com and use code MAMASTEPOD to get 20 percent off your first order.