Kristin Revere and Suzzie Vehrs discuss epidurals as an option in your birth toolbox in the latest episode of Ask the Doulas. Suzzie is a birth doula and childbirth educator with She Births Bravely.
Hello, hello! This is Kristin Revere with Ask the Doulas, and I am thrilled to chat with Suzzie Vehrs today. Suzzie is not only a doula, but also a childbirth educator and the founder of She Births Bravely. Suzzie has worked with hundreds of families on their journey toward childbirth and parenting. As a mom of two, Suzzie is passionate about empowering parents to make informed decisions about their birthing and parenting experiences. She uses evidence-based information and practical tools to help parents prepare for birth, whether that be at home or in the hospital, breastfeeding or bottle feeding, and early parenting. Her classes are designed to be inclusive, respectful, and supportive of all types of birth choices, including natural childbirth, medicated childbirth, and Cesarean birth.
Welcome, Suzzie!
Hello! Thank you so much for having me. It’s so fun to get to collab and talk with other doulas who I love and admire so much!
Well, I am thrilled to chat with you! And our topic is an important one. We are going to chat about epidurals, and I love that you are so inclusive, similar to my doula agency, is that you support all types of birth and parenting goals and feeding goals. I think there is a misconception, even today, with increased awareness for birth doulas, that birth doulas are only for unmedicated births or homebirths. But at my agency, I’d say half of our clients want an epidural. I can’t wait to dive into this topic and hear your thoughts on epidurals, not only as a birth doula, but also as a childbirth educator.
My clients are the exact same, and it’s so funny because a lot of my moms look at that and they, 50% of moms are getting epidurals? Really? That many people want it? And the other 50% are saying, oh, my goodness, 50% go without epidurals? How do they do it? It’s so great to see when people know what they need and are aware of, like, you know what, I need to have an empowered birth as this. And the choice will be different for different moms, but as long as it circles back to that feeling of being empowered and being what you need to have a positive and empowering and bonding experience with your family, then the decision is right, yes or no, for an epidural, either way. So I’m so glad we can talk about it because there are so many misconceptions about what it’s like, what some of the risks are, and why people choose either direction.
Exactly. I find it interesting, being in this work for going on 12 years, I have clients that want an epidural for one baby and then want to try unmedicated, or the opposite. So it is interesting. It’s not just one mindset. You may want to have a completely different experience, whether it was just to experience the lack of discomfort in labor with an epidural or to be able to move around. Sometimes with clients the epidural just isn’t working properly and they didn't have the greatest experience and had poor mobility. Some clients can get on hands and knees with support and get into all different positions, based on the strength of that epidural and if they have feeling or not. So it can really vary from baby to baby or individual.
Yeah, absolutely. I’m curious about – because I brought a bunch of data about the pros and cons, and I really feel like numbers are so important as we’re looking at exploring the fears some people have about epidurals and which ones are really founded or not founded. But I’m really curious. There’s a statistic – well, I guess two statistics that I saw early on in my career, actually even before I was a doula when I was making these decisions myself. One is that nine out of ten women with an epidural get enough pain relief that they don’t need additional medical support with pain. But then the other is that on average, an epidural lowers pain about three and a half points on a pain scale. What do you see with your clients as far as how effective epidurals are?
It honestly varies, and I think our bodies are all unique and different. People have different perceptions of pain, so I think it honestly varies. I have clients who it’s almost like a party, they feel so good. They’re putting on music and makeup, getting ready for the birth. And others are still feeling discomfort. I’m doing hip squeezes and trying to get them into different positions, and I feel like as a doula, no matter how good the epidural is, that I’m working just as much with my clients who get different pain relief methods, including the epidural, as I do with my unmedicated clients.
Yeah, I feel the same. I so celebrate when mothers can have the joy and excitement and we can get to that place where the room feels just exciting and is filled with that really positive anticipation and comfort in the moment. But I don’t necessarily – I think sometimes the expectation is that if I get an epidural, I’ll be completely out of pain. But one thing that I think surprises a lot of people with epidurals, even if they lower your pain, they don’t necessarily get you out of all of the pain or pressure. Some people only get relief on one side of the body initially or might have a window where they still have one spot that’s very hard to get to.
Those hot spots can be uncomfortable, yeah.
But then as labor progresses, some of that pain and pressure comes back, even if you’re getting increased doses and having the anesthesiologist come back. And even the anxiety piece, even if you do get out of pain, if you’re still – like, that mental aspect of how are you managing your emotions in labor becomes very, very important. Just because the pain is gone doesn’t meant the worry or the stress is gone. It seems like a lot of my clients find themselves very stressed out, even after getting the epidural, and that’s something we get to work through and talk through, and it’s nice to have somebody there where you can say, like, is this normal, what I’m feeling? Or how to advocate if it means getting the anesthesiologist back several times in the room to get an epidural that’s not working adjusted.
Yes. And sometimes, again, it’s perfect, and they are feeling great. I had two unmedicated births, so I’ve never personally experienced an epidural, but my clients who do, their experience varies. Some love it, and with every baby, they want that epidural as soon as possible. Others want to delay the epidural and get as much movement, work on positioning, until they feel like they need it. When I started as a doula, there was a certain point when you could no longer ask for an epidural, and now, especially with laboring down being so common in the hospitals I work in, I find that clients can, if they’re pushing for a longer length of time and they’re able to get an anesthesiologist in, then they can get an epidural when they’re in the pushing phase. I’ve had it happen. Where before, it was kind of like, well, you’re in transition. You have to get it now or you don’t get another chance. That is also a beautiful option, and I feel like there’s so many different reasons for getting an epidural. You mentioned the mental aspect of it. There could be some trauma in the past where they really need an epidural to relax their body.
Yeah, and sometimes it’s also about – can I tell you a wild birth story?
Yeah!
One time I was with a mom who was planning a home birth, and her labor went really well until she got to 10cm dilated. We were at home. She was pushing probably about two and a half hours with literally no change. It was so hard. We decided to transfer to the hospital, and the midwives came with us. When you do that homebirth transfer, usually, the midwives come. They talked to the OB, and then they hand off the case and the midwives leave and then you’re with the OB team. With this mom, we got to the hospital, and she got an epidural. And they let her sleep, which is wild, because this is where we’ve been past 10cm, and usually there’s this big thing about not pushing for more than three or four. But this OB was like, no, we’re just going to restart, so take a sleep. They didn't start counting the time pushing until after she woke up and started pushing again. So from the time she reached 10cm to the time that she had her baby was like nine hours because she had pushed for a few hours, then she got an epidural and had a really nice long sleep, and then she woke up and she had to push more. And I remember that I was brand new. This one of my very first, like over five years ago. And I remember the OB, when they were writing the notes and she was stating the time she started pushing, the nurse was like, oh, you started pushing at home, and the OB looked at me and said no, they’re starting now. I was like, I’m just going to keep my mouth shut here because I think she’s trying to help. I didn't want to get the charting wrong. It was so interesting to see the OB advocate for the patient in that way. Like, hey, I know you want this natural birth, and what you might need is time to rest and relax and wait. And it was amazing that she had this natural vaginal birth that started one way at home, that progressed very normally, that had a blip, you know, an unexpected turn, but then still continued on even with the epidural. Sometimes tools that we don’t initially think will be part of our plan end up being part of our plan, and that can be a good thing when we meet our needs as they evolve.
Absolutely. It seems like she didn't have any additional interventions, which can be a concern for some people with their birth plan with not wanting to have additional interventions. Obviously, avoiding a Cesarean would be an example of that, and there are stats that an epidural can increase pushing length and lead to other interventions including a surgical birth if mother and baby are not responding well. But it can also, as you mentioned, be an amazing tool in the toolbox. For some people, it could have been physical exhaustion for her. It could have been more of a mental block. So it’s really hard to tell sometimes, but it was obviously what she needed, and she had a provider who was on board with that. So I love that story! Thank you for sharing!
And I’m glad that you brought up some of the risks with the longer pushing. Should we talk more about some of the reasons why some people avoid epidurals?
Sure, yeah!
Or only use them on an as-needed basis sometimes?
Yes, fill our listeners in as if they’re taking your childbirth course!
Okay! I guess let’s talk first about the rare but real complications, long term complications, and then the short term, more resolvable things for moms and babies. Is that okay?
Yes, that’d be great!
I know when I ask people about what they’re thinking about epidurals and why they’re leaning towards one or against one, a lot of people tell me that they’re worried about long term chronic things after labor. The good news is that for things like chronic headaches, chronic back aches, things that might last 18 months or years after labor, are super rare. But it’s also important to know that they exist. Epidurals do go into that spinal space right into your back, and so for things like a chronic headache, about 6 out of 1000 people experience having headaches and 5 out of 1000 for the back ache. So it’s not a lot of people. The risk there is super low. For some people, that’s enough to say that I want to see if I can avoid it.
Absolutely. And again, everyone’s got their different mindset and goals and as I tell my students and clients, it is important to be flexible in birth. I’m a fan of calling a birth plan your birth preferences in order to not feel like you have failed if your birth plans change, just like your home birth client. It’s a perfect example. If she was not as open to different options, like an epidural, she may have felt like she did not accomplish her goals, but she ended up with a great scenario with a supported transfer and got exactly what she needed.
Exactly, yeah. Let’s see. Should we talk about other serious and rare complications with epidurals, as well? I feel like I don’t want to get too scary with any of the data, but I also feel like when you're making decisions, it can be really frustrating if you don’t hear about this until after something happens. Have you ever had any of your clients have the spinal headache?
No.
Okay. So about 4 out of 1000 people will have a spinal headache, which is actually quite treatable. But it’s really quite intense.
I’ve had clients with the back issue before.
Yeah, it’s just very unlikely. There are other short term side effects that are more common. For example, when you get an epidural, it can drop your blood pressure. About 14% of women can have shivering, ringing in ears, dizziness, nausea, vomiting. Some people will get itchy.
Shaky legs is very common.
Yes. And then you’re also at an increased risk of a fever with an epidural. About 7% of women who have the epidural for less than six hours will have a fever, but if you have it for 18 or more hours, that goes up to 36%, so if you were thinking about timing for an epidural, sometimes it does make sense to, even if you want an epidural, to try to get as far as you can without it, just because fevers, yes, they can be treated, but sometimes they do lead to Cesareans, things like that, more difficult recoveries. And then I think one of the more difficult ones to cope with is not being able to eat or drink and being put on a clear liquid diet. Something that’s not a big deal if it's for a short time, but if you’re in a longer labor, you’re 18, 24 hours in, and you haven’t eaten, it can become quite challenging.
I’m finding that it’s okay to snack now.
Your anesthesiologists are letting you eat?
I’m not talking full meals, but it depends on the hospital. But with some of the ACOG guidelines, it is okay to have a bite of an energy ball or something.
You are so lucky! Our anesthesiologists will not allow food after you get the epidural at all. It’s like popsicles, juice.
That’s the standard thing that the hospital, of course, offers, but if people bring in things – I’ve had my clients eat in front of the nurse, but again, just finger foods, snacks, and not a lot of it. Certainly, if they’re asking for something, it’s going to be a popsicle or jello or broth.
That’s amazing that they’re not saying anything. Our moms are getting just hammered with being – it’s just so highly emphasized, you cannot eat. Which I love that they’re being more open to it because the research really does show that, one, a little bit of food is good for labor for yourself, as a mother, but also that it’s not as dangerous as we once thought. That’s amazing.
But it can be exhausting. Back when there were more restrictions, I would talk to clients about electrolyte drinks – still do, and my students, and even some of those runner’s gummies that marathon runners will bring with them on those long runs to give a little energy without filling the stomach. And as you mentioned, nausea or vomiting could happen, so you don’t want to have a whole lot of food. You’re not hungry usually until after you deliver. But as you had mentioned with those longer labors, and certainly with my clients, if they’re having an induction, oftentimes they can eat in that earlier phase.
Yeah, we’re allowed to eat until you have an epidural, and then that’s about it for us. It’s so interesting, as I go on different podcasts and I meet doulas from all around the country, it is really interesting how the care changes based on your location.
Absolutely, yeah. And hospital to hospital, certainly. But there can be variations in every state.
Yeah. How do your clients usually feel about epidurals kind of being like a packaged deal with the IV fluids? And most – not all, but I see most of my moms with epidurals have Pitocin. Do you feel that a lot of your moms care about that, or is that something that is like it’s okay; it’s worth it?
Again, it depends on what their goals are and what their preparation was. At Gold Coast, we teach HypnoBirthing, and so that mind-body connection, and many of our students, their goal is at some point in labor, not all, but there are plenty of them in every class, that want an epidural at some point. Then others are taking HypnoBirthing for an unmedicated birth. We also have planned surgical births where they may have a fear of the surgery and want to be as relaxed as possible and use some of the breathing and mindfulness techniques. So I don’t see those that have a plan necessarily having an issue with Pitocin because they won't necessarily feel it as they would if they were having an unmedicated birth, and certainly the IV is part of the package. So again, it just depends. Is this someone who wanted an unmedicated hospital birth as homelike as possible and then needed to have other interventions? Oftentimes, I see Pitocin comes first and then with the discomfort, some of my clients – not all – choose an epidural. And others are totally fine with Pitocin and managing that without having any sort of pain medication.
Yeah, I see a lot of my moms – Pitocin is kind of like the moment where they switch to, okay, I was fine before, but now I just really want to get comfortable. But I do have outliers who are totally fine with the Pitocin and make it through even the induced labors without an epidural, which I think is important because sometimes labor is mind over matter. In some cases; it’s not always. There’s always an element of that, and sometimes there’s additional things out of our control where we just need to meet these emerging needs. But I really love how even your moms who are planning an epidural are working on their pain management skills and tools because it is true that even if you have an epidural, you do have to get far enough into labor to get admitted, and you do have to cope with contractions. And so to use an epidural as a tool but not as an excuse to not get prepared and not get the groundwork – it’s really amazing that your moms are taking that point of view and putting that work in to ensure that they have a positive birth.
Yes. And as you had mentioned earlier in conversation about how some of your clients feel that pressure in pushing – which is good and can make it more effective – and others don’t, which then can lengthen the amount of pushing – so breathwork is so important, whether you can feel your pushes or need to be directed and have the ten pounds and so on and have a lot of support on when the contraction begins. But I have clients with epidurals that can feel the start of a contraction. It just varies.
And I feel like for a lot of people, as they’re getting later into labor, as their baby is coming down really low, I hear a lot of moms start saying, I feel like I have to poop, and I’m like, okay, it probably is not poop – or maybe it is, but it’s also probably your baby coming really low, and that’s a good time for us to start talking about paying attention to, is that feeling there all the time, or is it coming and going? Is it getting stronger and weaker? Because a lot of times as you start paying attention to that feeling, it goes from being like, oh, just an abstract feeling to like, oh, actually, this feeling is adjusting and changing, and that’s what my contractions feel like now is this pressure. And then as you’re building awareness and paying attention and you’re tuning in to your body, even with an epidural, a lot of moms can start to feel like, yes, this is when I push and no, this isn’t when I push, and this is when I’m on my break, and I think it can be very empowering to push with an epidural, even if it looks a little bit different than pushing naturally.
Right. We’ve talked about some of the risks and statistics. What are some of the benefits of an epidural?
The biggest one is hopefully you’re out of pain, at least significant pain! Like we said right at the beginning, that first statistic that nine out of ten women get adequate pain relief and don’t need additional support with labor pain, and that it does lower the rating on the pain scale on average three and a half points. I’d say for a lot of people, though, just from my observation – you know, I don’t want to disagree too much with somebody who went out and did the work to ask people and record it and publish the research – but I would say it truly is an average, meaning that some people get much more pain relief and do sleep and relax and get a break from the pain, and if you are just at the three and a half points, then it’s probably not a full, complete, out of pain, but it is out of suffering for most people. I think pain and suffering, they can go hand in hand, but they don’t have to. When I’m working out, I’m usually not suffering, but I push myself and have that more intense experience. But they often do in labor go hand in hand if you haven’t done the work to separate those, right? Anyway, three and a half is significant, but it's not everything, so I just hope that as moms are thinking about an epidural and setting their expectations, to know it’s okay and it’s normal if you’re in some discomfort. As long as you’re out of that place where you’re suffering, I’d say an epidural is a success.
Right. And then again, it can be positive for someone who experienced abuse or trauma to be able to open up and relax during birth. That certainly is something that I have witnessed. Once the epidural is placed, it’s completely different.
Yes, and I think any time we get a choice and we have control, that control can come in different ways. For some people, control is learning how to work through contractions and feel grounded in that. And for other people, control is saying, that’s not for me. I want the epidural. And so whichever way people land on that, getting the support that is so important.
Absolutely. And for some options as far as pain management, a narcotic is not a good option for people. They don’t want to feel out of body. They know they have negative reactions to certain medications. So they’re not interested in something like Stadol or Demerol and know that unless nitrous, which isn’t offered in every hospital, is a good option for them, that they might go straight to the epidural and avoid something as far as other pain management options, like that Stadol or Demerol.
Right. One question that I get a lot from my moms is about breastfeeding and epidurals. I know some moms worry about whether getting an epidural affect their relationship breastfeeding. Are you okay if we talk about that real quick?
Sure!
From my point of view, I’m a research girl. I love being in the studies. And the truth is that there is a lot of mixed research about epidurals and breastfeeding success. Some research says it makes no difference, and some says that it is a little bit more common to struggle with breastfeeding after an epidural. I think one thing that’s really important to note, though, is that pretty much every baby after they’re born will lose a little bit of weight. It is more common for babies of mothers who had an epidural. They have also had a significant amount of fluids throughout labor typically, and so sometimes those babies come out – like if you look at yourself and you’ve been on the epidural, and you’re like, oh, I look a little bit bloated. My hands look a little bit bigger. My feet look a little bit bigger. Babies can be bloated as well like that. Not that it’s dangerous, but it is normal for babies to lose some weight. Typically, we say about 10% is normal and we hope that they start gaining after that. If you have a baby that’s breastfeeding and you're right around that 10% and you had an epidural and you had a lot of fluids, it’s probably a little bit less worrisome than if you did not have any fluids during labor, just because it would be normal, just like you are shedding that extra fluid after labor, your baby is going to shed that, too. So I do like to give people a heads up for that because I see a lot of moms go and find their baby has lost close to that, like 7, 8, 9%. And then it’s like panic mode with all the interventions with breastfeeding and just lots of extra work with adding extra pumping and extra check-ins and extra visits. And while it is good to keep an eye on it, it’s also more normal if you have an epidural to be closer to that full 10% weight loss.
Thank you for sharing that! Any final tips for our listeners, Suzzie?
I’m a mom that’s had an epidural and has not had an epidural. Unfortunately, I did have a surgical birth after my epidural, and that was part of the reason that I decided not to do an epidural the next time. Even with that, I would say that when I look back at my birth stories, I wanted vaginal births both times, and I didn't get that both times. I only got it the second time. And yet I still don’t regret meeting my needs at the time. I think part of the way we make decisions as we’re going through motherhood is that we come as we are, right? And it’s okay for us to be imperfect and it’s okay for us to want tools and to use tools available, knowing that they have benefits, they have risks, and we might go through some of those moments that are the more difficult moments or we might have moments where we choose something we initially wouldn't have. And that’s okay. We should be proud of ourselves in those moments for meeting our evolving needs, and we should also just recognize that we have the strength and capacity inside to meet the challenges that are ahead. I think some of that growth is part of the labor process, no matter which way you give birth, that it can be positive; that it can be good; that you will bond with your baby; that you have this beautiful life together, no matter which way you gave birth. That would be my final words. Like, make a plan that reflects your values. Get support around it. And then honor your journey no matter what it is.
Excellent advice, Suzzie! Thank you! So how can our listeners connect with you?
I’m on Instagram at She Births Bravely. You can also check out my website. I have a lot of in depth articles about recipes, about nutrition, about the pros and cons of different choices on my website. So if you have more questions, just reach out. There’s a good chance we have resources that go in depth on a lot of the questions that people ask about labor and about the experiences before, during, and after.
Lovely. And you’re on Facebook at She Births Bravely. And for our clients who may want to work with you in person, where do you serve geographically?
I’m in Seattle.
Excellent! Well, thank you again, Suzzie, and I appreciate all of your information on epidurals!
Thank you so much for having me! Much love to all of you and all of your listeners!
IMPORTANT LINKS
She Births Bravely
Birth and postpartum support from Gold Coast Doulas
Becoming A Mother course
Buy our book, Supported
