Yes! Your doula client CAN Move with an Epidural!
We LOVE providing education around here! Whether for Doulas or parents. Our favorite way of teaching doulas how to facilitate labor movement is with our Prep4Birth™️ course! Get certified to bring this education to your community! Our group of certified 4TFM Instructors include doulas, childbirth educators, and fitness pros alike. Take the first step today!
Hey Doula Sis - How many times have you heard something like this…
You can’t put an epidural client on hands and knees…
You can’t move an epidural client into a side-lying push position...
We don’t have peanut balls...
She’s on magnesium, she can’t move...
Do what you want, but I don’t buy into that positioning stuff…
You can’t... We don’t do that... I can’t turn her over...She’ll fall off of the bed…
The hospital “policies” in place are often antiquated or are, in fact, not actual true policies. There can be a lot of resistance to something “new”, right? But truthfully - and the evidence proves this: There are very few reasons why a client with an epidural should be denied access to movement. The evidence on movement and positioning in labor is clear, and we should get the word out.
Historically, women have preferred upright positions for labor and birth. With medical “advances” (many of which we are grateful for!) the practices of laboring in bed or pushing on backs have increased. With the rate of epidurals in some hospitals is as high as 90% in some countries, and in America where the rate is about 65-75%, if you are a birth professional - Listen Up! You need to know how to help your clients/patients MOVE their bodies in labor.
“Motion is lotion! Our job as Doulas is to move our epidural clients as if they were unmedicated.”
In this blog, let’s take a look at HOW to support a client in hands and knees with an epidural (otherwise, I would need to write a manual instead of a blog… oh! I already did that with the Prep4Birth™ certification!)
Laboring client in hands and knees with an epidural in place using the CUB and a peanut ball for comfort.
Let’s just take getting on hands and knees as an example. With help from the nurse or partner, as a doula, you can easily prop an epiduralized patient on hands and knees with a CUB and a peanut ball. Do you see how the sheet is anchoring the peanut ball in place? This is a great hands-free way to secure the peanut ball and give your client support to help her stay in place.
You can also encourage partner involvement by showing them how to rock their beloved in the hands and knees. As you can see below, this partner stood behind the peanut and gently rocked the peanut forward and backwards which in turn rocked my client. This achieves deeper relaxation and constant movement of the pelvis which encourages fetal descent and labor progression.
What’s in your doula bag?
In mine, I always carry a peanut, a CUB and a small air pump for inflation. That way, if the hospital doesn’t carry these items, I have them!
And while your client is in that position, try these 3 steps to open the pelvic outlet in hands and knees:
1) Step to the inside of your client's feet and use your legs to widen her feet.
2) You’ll have clear access to her hips and back for comfort measures such as Double Hip Squeeze
3) The Doula rocks or rolls her client so that the client can be in the most relaxed and released state of mind.
This client in the video was unmedicated, but this works beautifully with any hands and knees support. You notice that I am explaining to her that I am subtly moving her feet out wider, as if in a squat to open her outlet of her pelvis. Because she is unmedicated, she is resting over a birth ball. If she chose an epidural, I would have used the CUB for her upper body support.
Prep4Birth™ where expectant moms learn how to use the birth tools and their bodies to have a better experience of the birthing process.
We LOVE providing education around here! Whether for birth pros or parents. Our favorite way of teaching parents how to facilitate labor movement is with our Prep4Birth™️ course! Get certified to bring this education to your community! Our group of certified 4TFM Instructors include doulas, childbirth educators, and fitness pros alike. Take the first step today!
If you are interested in learning more about labor support using the peanut ball, check out this blog!
References:
BAŞAR, F. (2023). POSITIONS USED IN LABOR. Academic Research and Reviews in Health Sciences, 7.Satone, P. D., & Tayade, S. A. (2023). Alternative birthing positions compared to the conventional position in the second stage of labor: a review. Cureus, 15(4).Stremler, R., Halpern, S., Weston, J., Yee, J., & Hodnett, E. (2009). Hands-and-knees positioning during labor with epidural analgesia. Journal of Obstetric, Gynecologic & Neonatal Nursing, 38(4), 391-398.Stulz, V., Campbell, D., Yin, B., Al Omari, W., Burr, R., Reilly, H., & Lawson, K. (2018). Using a peanut ball during labour versus not using a peanut ball during labour for women using an epidural: study protocol for a randomised controlled pilot study. Pilot and feasibility studies, 4(1), 1-10.