Latest / The Birth Lounge Podcast / Ep. 448: Epidural Experiences: 3 things that can go wrong with an epidural and How to Manage It solocast with HeHe Stewart

Transcript

Ep. 448: Epidural Experiences: 3 things that can go wrong with an epidural and How to Manage It solocast with HeHe Stewart · The Birth Lounge Podcast

• Calling back your anesthesiologist can be such a make it or break it experience because if you're feeling a window and that is causing you internal anxiety or that is causing you emotional, mental turmoil and you are not able to fully relax, it is going to impact your labor.
• 0:19
  So.
• 0:19
  Our goal with getting an epidural was getting you relief so that you could be comfortable and you could relax, and we really want to do that.
• It is live.
• Our Mother's Day sale is officially going you guys run don't walk, because there is just a few more days left.
• This sale has been going on since Monday, so you're already late to the game.
• I know you're probably dreading opening up another bag of a pair of slippers or another robe, or maybe even some earrings that what you're gonna wear once or twice a year.
• Instead this year, ask for the gift that is going to literally change your life.
• We are running our one of only two sales every year.
• This Mother's Day, you can save $150 on a lifetime membership of the birth lounge, and this is the gift that's gonna keep on giving.
• And when I say that, I genuinely mean it's going to change your life.
• The way that you birth is the way that you live after having a baby.
• It is the entire launch pad for your motherhood experience.
• The birth lounge is known all over the world for helping women avoid birth trauma and having birth that they love.
• I'm going to teach you the stages of labor, duh.
• How to have your pain-free labor with different positions and pain relief methods.
• Duh.
• But more importantly, I'm going to teach you how to confidently navigate the hospital system and make decisions that serve you and your baby in a way that feels best aligned.
• To you when you look back on your birth, I want you to feel elated.
• Joy.
• I want this big ass smile to be slapped across their face and for you to remember what a badass you were that day.
• I want those feelings to come rushing back for you.
• That's how I feel when I think about the birth of my son, and I did exactly what I'm teaching inside the birth lounge, and I want that for you.
• I know that you have heard so many horror stories of birth being painful, unpredictable, go in every which way except the way that you anticipated and you expected.
• But that does not have to be your story.
• The birth lounge is going to teach you, and I'm talking, really teach you on a cellular level, leaving no stone unturned, how to prance into that hospital confidently and empowered so that you can have a positive hospital birth.
• This sale starts on May 4th, and it ends the Monday after Mother's Day.
• Head to the birth lounge.com/join
• on May 4th through May 11th.
• And use Code MAMA 150.
• That's MAMA.
• 1 5 0 Mama 150 to save $150 off of your lifetime membership in the birth lounge.
• Again, that's head to the birth lounge.com.
• Use Code Mama 150 and join the birth lounge.
• I am telling you firsthand, I had my dream birth and not everything went according to my quote unquote plan.
• But I still look back on that day and it is the best day of my life.
• I have absolutely zero birth trauma, even though my labor was three days and I pushed for many hours.
• I want this for you.
• Go to the birth lounge.com.
• Use Code Mama150 from now until May 11th.
• Do not miss out on this sale.
• I'll see you in the birth lounge Hello and welcome back to another episode of the Birth podcast.
• How's it going, you guys? You guys? I.
• Could not be more excited to be back from maternity leave.
• I absolutely loved taking time off to be with sgi, but I really did find that I craved productivity.
• I craved getting back to you.
• I craved having these conversations now.
• I knew that was gonna be a thing because you know, I'm so Type A.
• I just am kind of a busy body and I always love having conversations and obviously when you're stuck at home with a newborn, it can kind of be like, how many times can I sing Old McDonald before I rip my eyes out? However, one of the things that I was super, super stoked to get back to were the conversations that you guys had requested.
• So all of 2025 were conversations that you had asked for.
• Previous to that, the show was really comprised of topics.
• That I wanted to learn about or I thought were really important for you to know when you started to embark on trying to conceive and having a baby and your postpartum period.
• But one thing that I found in 2025 was that it was really invigorating to have conversations that not only did I know that you want to hear because you had asked for them, but they were conversations that otherwise I probably would've never had on the show.
• We are going to continue that trend in 2026 because we have a long list of topics that we actually didn't get to last year that we're gonna carry over into this year so that we can have the conversations that you have asked for, and today is one of those.
• Now, I know so many of you out there are striving for unmedicated birth, and I love that for you.
• I absolutely loved my unmedicated birth.
• It made me feel so powerful and on the days or in moments where I feel really weak or maybe my self-confidence is feeling a little low, or I start to self doubt myself, or I start.
• Question myself.
• I remind myself how much of a badass I am because I labored for three days.
• I pushed for many hours, my son crowned for 90 minutes, and I did all of that without any sort of pain relief other than non-pharmacological like heat and the tub and massage and different movements.
• I just remind myself how empowering unmedicated birth was.
• However, I was open to an epidural and I know for many of you.
• That isn't your plan.
• Unmedicated birth is not anything that you are interested in.
• In addition to that, even for people who are striving for unmedicated birth, I want you all to realize, and we talk about this a lot, keeping flexibility in the fact that you may reach a point in labor where an epidural actually is a really productive and beneficial tool for your birth.
• I want to have a discussion that has come up many times with our one-to-one clients and that is where.
• Can an epidural go wrong? What does that look like in your birth? And then how do you get yourself out of that situation? Or what is the remedy to the epidural going wrong? Now today's conversation is not gonna be about pros and cons and alternatives and what to expect from the epidural placement.
• I've already covered that in episode 4 0 4, when I interviewed Marissa Mulder, A-C-R-N-A.
• Instead, today we're gonna talk about once your epidural is placed, how can things go awry and what do you do? And I'm gonna talk to you about the three most common things that I have seen over the last decade of being a doula.
• So let's go ahead and dive in to number one.
• And this is probably the most.
• Common thing that we see is that once you get your epidural placed, it is too dense or it's too heavy, it actually numbs you up.
• Too much, and this is a big problem because not only can it feel really concerning and it can make you feel a little scared because having your body be numb while you are awake is a really.
• Uh, I don't know.
• It's like an out of body experience says a lot of women.
• I obviously have never experienced an epidural, so I can't speak from personal experience, but what I can say is over the last 10 years, I have supported thousands of families and.
• Hundreds of those people have chosen to have an epidural.
• And so what they say is that you mentally know, you emotionally know.
• Like intellectually you can conceptualize yes, my legs are still there.
• Yes, I still have control over them, and this is a temporary paralysis, however.
• Feeling can be very, very disturbing.
• And, and a lot of people say that it's really freaky to fill this.
• And so one of the things that we want to do is make sure that your epidural dose is tailored to your body.
• Now, there are two parts to this.
• Number one, where they put it in your back, and number two, the actual dose of the medication where they place it in your back.
• This is a conversation that you wanna have with your anesthesiologist before they place your epidural.
• So you really want to be really upfront with your anesthesiologist and tell them exactly what you're hoping for in terms of the goal of relief from your epidural.
• It may sound something like this.
• Look, I am just looking for some light relief, but I would love to still have full control over my legs as much as possible.
• This is going to clue in your anesthesiologist, A, where to place your, your epidural, and B, how much of a loading dose, so that initial dose of pain medication to give you.
• From there we can titrate your medication up or down, and titrate is just a fancy medical term.
• That means turn it up.
• Or turn it down.
• We have the ability to change the amount of medication that you're receiving from your epidural at any point in labor.
• And so once you have your epidural placed and they give you that loading dose, you're going to see that in probably the next hour or so you'll have.
• Full relief and we will kind of know exactly what kind of relief your epidural is going to provide you From there, you wanna be very communicative with a nurse that is with you on how that is impacting you.
• Is it enough? Is it too much? And then you can of tailor it to be exactly what you want.
• The other thing about placement to really tell your anesthesiologist before they place your epidural is exactly where you're feeling your contraction.
• So based on where they put it in your back is going to determine how high up your epidural impacts your body.
• So if you are really far along in labor and your contractions are already very, very low in your belly, almost in your pelvic region or your hips or your lower back, and they're not so much above your belly button.
• Be sure to tell your anesthesiologist this and they can actually place your epidural to impact the lower part of your belly and your legs rather than impacting your entire belly.
• This may bring you a little comfort having more of your body not under that paralysis, right.
• The other thing is if you have any sort of, like bad reaction or if you know that you react really sensitively to narcotics or to pain relievers, go ahead and tell your anesthesiologist that as well.
• And then again, like, like I just mentioned, if you're hoping to have a really light epidural, almost a walking epidural, if you've never heard of a walking epidural, this is where, it is.
• Place very specifically, it is a really light dose, and the idea behind that is that you can get up and you can actually still be mobile while having the relief of an epidural.
• Now, one thing I will tell you about a walk-in epidural is it's very rare to find A, an anesthesiologist that has the skill to place an appropriate walking epidural.
• And B, because hospitals are so litigious focus.
• They are, you know, very scared of litigation against them, and in addition to that, labor and delivery is.
• You know, the unit, so they say that has the most litigation brought against them.
• It is really, really, really hard to find a hospital that is going to okay you getting out of bed.
• And so I wouldn't get your hope set on having a lock in epidural, but it is an option.
• I have seen it a handful of times, only at one hospital in the Boston area, and it's actually not one of our city hospitals.
• It's a hospital that is out of the city.
• Um, and in the last recent years, I actually haven't seen it.
• I don't know if they had a change in policy or if their anesthesiology team made any changes, or maybe the anesthesiologist who was capable of doing walking epidurals no longer works there, but it's not something that our team has seen recently.
• So a walking epidural can be really hard to find.
• However achieving that really light placement of an epidural where you have appropriate pain relieve you are not feeling the full intensity of your contractions.
• You are comfortable in your labor, but you still have control over your legs is such a sweet spot to be, and when I say have full control over your legs, when we say wiggle your toes, you should be able to wiggle your toes.
• When we say roll your ankles, you should be able to roll your ankles in a really great placement.
• We should be able to say, you know, bend your knees, pick up your legs, can you get yourself onto hands and knees? And you should be able to bend your knees and pick up your legs with.
• Pretty much no problem in getting yourself on hands and knees with minimal problems, so minimal help from the support staff around you.
• And the heavier your epidural, the denser your epidural is, the more help you are going to need to get into various positions, because that means you are more numb, right? And so if you have absolutely no feeling over your lower back, your hips and all of your legs, then getting into more complicated or complex positions like hands and knees or squatted or like a fire hydrant where you're on hands and knees, but you have the, the peanut ball under one knee and it's kind of out to the side of you, almost like a dog would be peeing on a hydrant.
• That is gonna be really difficult and you're gonna require a lot of hands-on support in order to get into, into those positions by your support people.
• So your partner, a doula, if you have one, your nurses.
• Um, and in a lot of cases, if you have a really dense epidural, you actually may run into the place where your medical staff tells you that you can't get into these certain positions, you know? In good old HeHe fashion.
• I'm just gonna be devil's advocate here.
• You still absolutely can, so don't be afraid to push back on that.
• Don't be afraid to say like.
• I do really want to get into this position, so if you can't help me by yourself, could you please call in some additional nursing staff so that we can get me into hands and knees, especially if you really know that hands and knees is a place that you are comfortable, or a place that you're gonna be really productive and efficient in laboring or pushing out your baby.
• Don't be afraid to advocate for yourself.
• Don't be afraid to ask for that extra step.
• Don't be afraid to push your nurse to go that extra mile, to get some colleagues in there so that you have enough people to get you into that position.
• I can tell you from experience that if I was forced to be on my back, my entire labor with or without an epidural, it would have been just really terrible.
• I found so much comfort and I made so much progress with moving positions and it, it brought me actually a lot of control because when I felt like one position wasn't working, all I had to do was say, I don't wanna be here anymore.
• And my team, I mean they were, they were so lovely, but they would just say like, okay, great.
• Where do you wanna go next? And I really want to remind you that that type of support exists and that you deserve that type of support, and so don't let anybody on your team, whether it's medical or not medical, convince you that because you have the epidural, you can't get into certain positions.
• Now what do you do if you find that your epidural is too dense or too heavy, or that you don't have the appropriate, you know, leg control that you need? We should call the anesthesiologist back in and have them turn it down.
• By turning down your medication.
• I know that sounds really scary for a lot of people, and you're like, wait, wait, wait.
• Now I got the epidural because I didn't really want to feel what the intensity of the contractions were like.
• So if I turn it down is that going to come back? And the answer is no.
• Now, you might feel a little bit, but that's the goal, right? Like you don't wanna be so numb that you can't feel anything because with that, you don't know how to move your body.
• You can't feel your baby dropping and Spinning in your pelvis.
• You don't know how to push, when to push, where to push, where to put your efforts in pushing.
• And the other thing, and this is kind of dangerous, is if you do get into other positions, we don't know if we're harming your body.
• So we can actually cause harm by over extending your knees or your hips, or sometimes if you can't feel your ankles and someone is pushing against your ankle for some counter pressure, you might come out of a really dense epidural and say, oh my God, my ankle is so sore.
• Or, oh my gosh, my hip feels like it is just destroyed.
• If you are not able to feel the pressures and the sensations in your body because the epidural is so dense, so heavy that you've lost all the feeling, then we actually don't know whether we're properly supporting your body ergonomically or not, and that can be really dangerous.
• So.
• If you get into a situation where you find that your epidural is too heavy or too dense, tell your nurse, this is too much.
• I'm not feeling what I want to feel, and I would like to have a conversation about turning it down.
• Now, likely.
• In many, many units, your nurse is not going to be able to do that.
• Neither will your OB GYN, or your midwife.
• Almost always.
• It requires the anesthesiologist to come back to your room to have a conversation and for you to tell them about your goals and then for them to make adjustments.
• This can be a roadblock in some conversations, you may feel like your medical staff, your nurses, your midwife, your OB GYN, are almost.
• Discouraging you.
• They are trying to persuade you to just have the epidural that you have.
• Do, let's not call back anesthesiology.
• Or they may phrase it like, well, we'd have to get anesthesiology back in here if you wanna do that.
• I really encourage you to say, okay, great.
• Let's call 'em back.
• You know? And they may say something like, well, they're in surgery, so it may take them a little bit to get down here.
• Awesome.
• I'm willing to wait.
• And so.
• In that time that you're waiting for anesthesiology to come back to your room, your body is just laboring, so you're not causing any harm.
• However, you probably aren't able to get into the positions that you want to get in, and so this would be a really awesome time for you to take advantage of some sleep and to rest.
• Right.
• Go ahead.
• And rest up.
• And then when anesthesiology gets back into your room, you can have a conversation about what your goals are.
• They can turn down your epidural or titrate it like we just learned.
• And then hopefully in the next hour or so, you will get some feeling back and it will be to the appropriate level.
• Now, let me tell you this, if they turn it down too much.
• And you find that you need a little bit more, don't be afraid to call them back.
• Before you do that, try that PCA, so you're gonna have this handheld, um, I don't even know what to call it.
• It's, it's like a clicker.
• It almost looks like the clickers that they have on jeopardy.
• It's like a handheld thing, and it has this little button on top.
• And when you push that button, it is a PCA, it's a patient controlled administration, and you'll be able to push that button intermittently and then it will time out.
• And once that time elapses, then you will be able to, push the button again and you'll be able to get more medication.
• This is a way that you can be in control of the, the dose that you get.
• It's not going to up your dose enough that you know, if you weren't feeling enough pain relief that you, you may not need to call the anesthesiology back if, if you are not feeling the relief that you were hoping, chances are we need to have another conversation with the anesthesiology team because they probably need to either wiggle your epidural a little bit.
• Maybe pull it out a little bit.
• Sometimes when they place the epidural, it can be placed a little bit too far in that epidural space.
• Or they may actually need to increase your dose, but give that PCA a chance to work.
• Give that PCAA go try and self dose a little bit in your, in your epidural.
• And if you find that that doesn't work, then have a conversation with your nurse about bringing back in your anesthesiologist and they can again, adjust things to your liking to help you get comfortable.
• Because remember.
• One of the things that is gonna hold up your labor is if you aren't comfortable.
• If you're not feeling safe with the people around you, if you're not feeling safe in your environment, if you're not feeling safe in your body, which includes the things that you're feeling or not having, the pain relief that you thought you were gonna have.
• Then your labor is not going to progress in a efficient manner, right? We're gonna see these lags in your labor.
• We may even see that your contractions space out or they get really light, or they become infrequent, or you just are not making as much progress as what we had either previously seen or what we had expected for this part of your labor.
• So make sure that you are.
• Advocating for yourself.
• I mean, it really comes down to not letting people talk you out of advocating for yourself, even if it means having anesthesiology come back to your room once or twice, maybe three times.
• Everyone's body is really different for some people.
• That Epidural placement is gonna be placed, and it's gonna be right the first time and it's gonna be smooth sailing.
• And then for some people you are going to need a little bit more tailored care to get your epidural placement right, and that is a, okay.
• Guys, it is finally here, our Mother's Day, sale.
• This is only one of two sales that we run every single year, and it's finally here.
• I'm so excited to share it with you.
• You can now get $150 off of your lifetime membership to the birth lounge.
• We run sales at Black Friday and Mother's Day, and that is it.
• May 4th through May 11th.
• use Code MAMA 150.
• That's MAMA.
• 1 5 0 Mama 150 to save Mega time on your lifetime membership of the birth lounge.
• Let me give you a little rundown about what makes the birth lounge so special.
• It is literally unhinged.
• It is like nothing else you're gonna find out there on the market, and that is the way that we are able to have the results that we have.
• We have people that literally walk away with absolutely zero birth trauma and they achieve all of their birth goals and they have no tearing and the best one yet is that we have just a 3% C-section rate.
• Yeah, I am able to help you truly go into the hospital system, navigate the conversations with your provider, stay in control from start to finish and avoid unwanted interventions and unnecessary things like an unnecessary C-section or an unnecessary induction.
• So how can this be? Well, I'm teaching you the control method, which is going to help you under understand all of the aspects of labor that are within your control.
• And then we're gonna teach you how do you control them? The problem that I find with a lot of traditional childbirth ed classes is that they just teach you your options.
• They say, well, you can have this, or you can have that, and these are what your options are.
• But then when you get in the hospital system, you find that you're getting pushback from staff, or you are feeling like you don't really have those options, or maybe you're feeling pressured and you don't know how to navigate those conversations, that's exactly what I teach you how to do.
• I'm deconstructing all of those barriers, those road bumps, those things that hold you up from actually achieving your goals, because just knowing your options is not enough.
• The birth lounge is a comprehensive course, so when you go with the birth lounge, you will not need.
• Any other form of preparation when it comes to preparing for your birth.
• Inside the birth lounge, you are gonna learn stages of labor, the ins and outs of navigating the hospital system, how to engage in respectful, collaborative conversation with your medical team, pain relief options, labor positions.
• Pushing positions, how to reduce tearing.
• How do you avoid things like induction, C-section, and unnecessary interventions? And finally, how do you advocate for your goal so that you can say yes to the things that matter to you.
• You can request alternatives when that's appropriate, and you can decline things that don't feel good to you.
• Plus, in the lifetime membership, you're gonna get.
• Free access to our dad daze course, which is a comprehensive course made for male partners to help them understand how can they best support you in pregnancy? What is their role in labor and delivery? How do they advocate for you? How can they keep you comfortable and provide pain relief during the birth experience? And then finally, what is their role in postpartum and how do they help you navigate this new space of becoming a mom in the best way possible? You're also going to get access for free for our secret sauce to pushing.
• This is where I teach you how to achieve those results I talked about in the beginning, avoiding tearing, and really understanding what muscles to engage to properly push your baby out.
• First of all, your pelvic floor does not push your baby out.
• That lady needs to yield out of the way.
• So what muscles do you use? That's exactly what I'm teaching you in the secret sauce to pushing.
• And yes, I'm teaching you how to push with an epidural and without an epidural.
• Don't worry.
• I don't really care how you birth your baby, I want you to be equipped no matter what pops up in your labor because this is your birth.
• I want you to choose how you wanna do it.
• My job is to make sure that no matter what choice you make.
• You feel empowered in doing that.
• You're also going to get one of my number one downloads, which is our scripts for advocacy.
• This is an entire packet of the most common conversations that you are going to face in labor and in the end of pregnancy that.
• Often start you down this slippery slope of handing over your control.
• Not only do I provide you with the evidence to have these conversations, but I'm actually giving you the words to have these conversations.
• IE the scripts for advocacy.
• In addition to that, you're gonna get all of my PDF guides.
• Partner guides, epidural guides, induction, cheat sheets, and my brand new Birthing Your Big Ass Baby course where I step you through the actual data of truly evaluating whether your baby is going to be quote unquote big or not.
• What does ACOG say? What does the AAP say and what are the true medical recommendations when it comes to suspected macrosomia, ie, a big baby.
• I think you might be surprised to learn that less than 1% of all babies in the US are born truly meeting the criteria.
• For macro somia.
• So why are inductions and C-sections so common? Well, that's exactly what I'm teaching you in the Birthing Your Big Ass Baby course, and I'm going to teach you how you can decline those if they don't feel aligned to you.
• And finally.
• Probably my favorite perk of the lifetime membership is you get a box that is handpicked by me curated to help you have your best birth possible.
• This is a birth box that includes all of my favorite things, not only that I have used for the last 10 years to help women achieve their best birth, but the same tools that I'm using in my own birth.
• Things like a TENS unit.
• A rebozo, a comb for painter relief, self-care items, breastfeeding items, and so much more.
• One of my favorite things is actually the fuzzy socks.
• I love them.
• They're so soft.
• Oh my gosh.
• This box is packed with goodies.
• It's worth over $150 and I'm sending it to you because I want you to be equipped to have the absolute most glorious and joyous birth experience that you possibly can.
• And I know that you can't do that without having the proper tools.
• And so not only do I teach you how to use those in the birth lounge, but I'm gifting them to you because I want them to be part of your birth bag.
• So through May 11th.
• you will be able to take advantage of our lifetime membership and $150 off.
• Head to the birth lounge.com/join
• on May 4th through May 11th.
• And use Code MAMA 150.
• That's MAMA.
• 1 5 0 Mama 150 to save $150 off of your lifetime membership in the birth lounge.
• Again, that's head to the birth lounge.com.
• Use Code Mama 150 and join the birth lounge.
• Do not miss out on this.
• If you miss this sale, you'll have to wait till Black Friday I genuinely cannot wait to help you have your best birth possible.
• I'll see you in the lounge.
• Bye.
• Now, speaking of not getting the relief that you were hoping for with your epidural, brings me to problem number two, which is probably the second most common thing I see as a doula with epidural placements, and this is called a window.
• Now, this is where you have an epidural that's placed and you have pretty good coverage everywhere, and you're pretty happy with it everywhere.
• Except one little place.
• Maybe it's in your hip, maybe it's in your lower back.
• Maybe it is in a specific place like the lower left quadrant of your belly, but in this place, it almost feels like the epidural just isn't reaching it at all.
• You are feeling full sensations of your contractions and therefore just like what we just talked about, you aren't feeling safe in your body.
• You're not able to fully relax.
• You're not feeling totally comfortable because, well, you're being able to feel those contractions, which is the point of getting an epidural so that you don't feel those contractions.
• Now in terms of how often we see windows, I'm not gonna tell you that they're rare because I actually don't feel like they're very rare.
• But I also will not tell you that they're super common 'cause I don't wanna set you up to expect that you're going to experience a window.
• What I will say is.
• They happen.
• Um, and it a lot of times has to do with the placement of the epidural.
• And this can be.
• Attributed most often to two different things.
• A, the skill of your anesthesiologist, and B, the structure of your back.
• So if you have anything like an abnormal curvature to your back.
• Scoliosis, any sort of scarring in your lower back, if you've ever had an epidural before, if you've had any sort of back surgery before, all of these things can make it a little bit more complicated for your anesthesiologist to place your epidural and to get you the, expected relief, right? And so when it comes to a window in fixing this problem.
• We have a couple of things that we can do.
• Number one, and I think is the easiest, it's kind of low key.
• We don't need to call anesthesiology back.
• You can inform your nurse, but you don't really even need your nurse's help to try this out, and it's just flipping from one side to the other.
• Okay? If your Window is on the left side.
• Then you want to use gravity to work in your advantage.
• And so we want to put the left side of your body on the hospital bed.
• We wanna think about when we stick an epidural in your back.
• We are putting liquid in your back, and that liquid is going to disperse in your body based on gravity.
• Okay? And so this is why.
• Almost always, once you have an epidural placement, they're actually gonna sit you up in bed.
• I think a lot of us, probably, if you've never had an epidural, if you've never seen one, and you're just learning about epidurals, you may think that they place it and then they lay you flat.
• We actually don't want that.
• We want gravity to work with us, and so we're gonna sit you up.
• They're gonna raise the back of the bed, and they're gonna have you in more of a.
• Seated position.
• You may be reclined a little bit, but your shoulders are definitely going to be higher than your chest, your belly, your lower back, and your hips.
• Okay? We want you in this upright position so that gravity can bring that medication down to your lower back, and your lower abs and your pelvic region and your legs and all the places that we are trying to achieve that relief that comes with an epidural, right? If you find that you have a window.
• Laying a little bit more supine, so a little bit more flat.
• You can definitely still have the back of the bed raised, probably not in a completely seated position, but lying down a little bit more.
• Use gravity and try and get that medication to reach the place where you have a window.
• So wherever your window is, whatever side of your body it is, you want that side to be closest to the ground, which means put that side of your body on the bed so that gravity can pull the medication to hopefully reach that window.
• Now, number two, we've already covered, it's that PCA, so that little, that little clicker button, go ahead and give yourself an extra dose, right? If you find that your original loading dose of your epidural didn't quite give you the relief that you were searching for, having you give yourself an additional dose of medication it might be really beneficial and I wanna, I wanna tell you two things.
• Number one, they have it set very specifically.
• You will not overdose on the epidural, okay? So you don't have to worry about harming you or your baby with using that PCA.
• It is really, really safe and they are not going to set it to a place where you can give yourself too much medication.
• Now, a little caveat there, which is number two.
• You can sometimes make your epidural a little too dense.
• Okay.
• So just be careful.
• One of the things that we teach our one-to-one clients, and we teach our members in the birth lounge is when you hit the PCA pump, no matter what the time that they have it set at, sometimes it's 20 minutes, sometimes it's 30 minutes, sometimes it's a little bit longer.
• Try and not hit your PCA for at least 60 minutes.
• That way you're able to get that PCA dose.
• It's able to get into your body.
• It's able to give you the relief that it's going to give you and you can kind of see how it's going to impact your body, how numb are you gonna be? Where in your body is it going to impact you and give you relief? And then is it going to stick around? One of the worst things that I see when it comes to PCA use is that people will click it, click it, click it, click it, click it, and then four hours later they're like, oh my God.
• My legs don't work and it's time for me to push this baby out, and I have zero control where when it was first placed, I had really good control over my legs, and I actually maybe overused the PCA a little bit much.
• So be sure that you're using that PCA sparingly, but don't, don't avoid using it so that you're miserable.
• I don't want you to not have the relief.
• Just use it very intentionally, right.
• So keep that in mind with the PCA.
• So number one, using that gravity, using movement.
• Number two, using your PCA and number three is actually gonna be calling that anesthesiology back, you wanna call your anesthesiology team back.
• Um, I know this can be a headache and I know that asking extra stuff of your staff can feel really daunting, especially if you are like me and you were raised to be, you know, quiet and a good girl.
• And you have this idea of being a good patient and you don't wanna be extra, but I'm telling you calling back your anesthesiologist can be such a make it or break it experience because if you're feeling a window and that is causing you internal anxiety or that is causing you emotional, mental turmoil and you are not able to fully relax, it is going to impact your labor.
• So.
• Our goal with getting an epidural was getting you relief so that you could be comfortable and you could relax, and we really want to do that.
• We want to achieve that.
• So have a conversation with your nurse.
• Do the things that we just talked about, try the different positions.
• Talk to your nurse and see if she has any other tips and tricks.
• Try the PCA button.
• But then don't be afraid to call your anesthesiologist back and have them adjust your epidural.
• I did just mention with the two dense of an epidural that sometimes they may need to wiggle your epidural, and so you might find that they have, you get back into the same position that you had when you had your epidural placed, and they might even pull it out just a little bit to have it.
• Not so deep in that epidural space.
• They might wiggle it a little bit to make sure that there's no kinks to make sure that it's really in there where it's supposed to be.
• And then worst case scenario, which is not a bad scenario, it's just something that your nursing staff, your ob, GYN, your midwife, your anesthesiology team, and you of course, are going to try and avoid, and that is replacing your epidural.
• This does sometimes happen.
• Sometimes we need to take out the epidural that has already been placed and we might need to replace it.
• You know, again, weighing the pros and cons of.
• If you have this window, how much is it impacting your labor? Do you think that it's causing you so much pain or it's making you so uncomfortable physically, or it's causing you a lot of mental and emotional anguish that replacing your epidural is actually the better option? So just think about that.
• Another thing that you might find, and this is gonna be anesthesiologist dependent.
• So depending on who the anesthesiologist is on at the time, they can give you an additional dose directly through your epidural in your back.
• So it's a little different than the PCA.
• Now this is called a bolus dose, and it is again, just gonna be a really big dose to try and help get you a little bit more relief with your epidural.
• Again, not all anesthesiologists are gonna be comfortable giving you a bolus depending on how your baby is tolerating the epidural, what other medications you have going on, some individual factors that may influence this decision and or just their comfort level with given additional doses.
• But it is something to absolutely know to ask about a bolus, B-O-L-U-S.
• Um, and again, if you're having this window, you've got a couple of different ways that we can get you some relief in trying and achieve some better comfort level.
• All right, and that brings us to number three, and this one, I will tell you is very rare.
• I have seen it happen.
• Less than the times.
• I can count on one hand in my 11 years of being a doula.
• And it is when you have an epidural and it's working really beautifully and then all of a sudden the sensation of relief just stops.
• Oh no.
• It's horrible.
• And it was, so many of you probably just were like, Ooh, that sounds terrible.
• Um, and in all honesty and all transparency, it is.
• It's really not great because in that case, unlike turning down a heavy dense epidural, you actually do get sensations of your contractions back.
• And for a lot of women, they will share that the sensations of those contractions feel super duper intense, sometimes even unmanageable.
• Um, because what happens in our brain is that when you're unmedicated, as your labor ramps up the pain relief hormones get released in your brain in an appropriate matching way to the pain that you're feeling from your contraction.
• So as your pain that you're experiencing rises, so does the hormones that will give you pain relief, right? However, once you get an epidural, we actually stop the pain relief hormones because, well, your brain is picking up, I'm not in pain anymore.
• And so it's gonna turn down your natural, endogenous hormones that are providing pain relief for you.
• However, the actual pain sensation with the contractions continues to go.
• Right? And so.
• You have this upward trajectory of actual sensation, and then you have this upward trajectory of hormones that provide you pain relief that at some point when you get your epidural, it stops and they get turned down.
• And so when your epidural stops working, or if you reach a place where your epidural stops working, now you have all of this part where you've got the sensation and your hormones of pain relief have not.
• Been there.
• They are not matching that.
• And so you are feeling these really intense contractions because you don't have any organic pain relief being produced by your brain because we have almost tricked your brain into thinking you're not feeling pain anymore because you had an epidural.
• So that's why these contractions are not stronger than anything that, that you can handle.
• They are not dangerous.
• They are not any stronger than they would have been.
• At that point in your labor, it just feels that way because you had gone from having pain relief with your epidural, and now your epidural has stopped working.
• So it feels really, really, really intense.
• Almost much more intense than what you would've experienced at that point anyway.
• Now this is one case in labor where we really don't have a lot of options.
• You can absolutely have anesthesiology come back to your room and they may try that bolus that we just talked about, and they may try to wiggle your epidural, but more than likely, what I have seen as a doula.
• Is they need to replace it completely.
• They need to take out the epidural that is, that is currently placed and they actually need to replace it.
• It could be that something malfunctioned with the epidural.
• It could be that, you know, during labor as you were moving positions or as you were moving around in the bed, as you laid on it, that it actually became misplaced.
• And then sometimes we just don't know why it stops working.
• But usually the remedy for if you have an epidural and it just all of a sudden stops working and you get that sensation back is actually going to be to replace that epidural, which just like the original scenario of it, just stopping working.
• That is really not an awesome situation.
• And I know it's something that so many people are like, oh my gosh, I hope that doesn't happen to me.
• I don't think it will.
• And here's what I'll tell you.
• It is really rare.
• It really, really is so rare for the most part.
• Once your epidural is placed, the epidural that is originally placed is the epidural that you will finish out the duration of your labor with.
• Um, and remember that today's episode is talking about complications, complications in labor that are already.
• I'm not gonna say rare, but they don't happen as often as good placements or as often as epidurals that give you great relief, right.
• And so I want you to just keep that in mind, keep that perspective that today's episode is about complications, which are not gonna happen nearly as often as a good epidural placement that gives you and achieves that sensation, that relief that we were originally going for.
• All right.
• There you have it guys.
• Those are the three most common complications that I see when it comes to an epidural placement and what you can do about those things.
• Again, like I mentioned in the intro to this episode, if you wanna learn more about an epidural placement, the pros, the cons, what you can actually expect from the placement, any sort of alternatives that we have, the medications that might be used in an epidural check out episode.
• 4 0 4 with Marissa Mulder, who is A-C-R-N-A, and she has placed thousands of epidurals before, and it's a really, really great episode.
• I want you to be confident in choosing an epidural.
• I want you to have it as an option regardless of what your goals are for your birth.
• If you are planning for an unmedicated delivery.
• That is awesome.
• But don't forget, having a backup plan and knowing how to be flexible and how to pivot in your birth is going to be crucial for you staying in control of the decisions that are made.
• The very worst thing is that if you are planning for one type of birth and that birth becomes no longer achievable for you, and then you are forced to make a decision that you never have thought about before, you are likely going to come out of your birth with trauma, however one of the very reasonable, easy, very cheap things that we can do, it's free, is go ahead and think about other options.
• Go ahead and think about, okay, I have my ideal birth in my brain, but if I can't have that, if I run into places in my labor work that's not possible for me, what else would I want? This is how we avoid birth trauma.
• We go ahead and think about where is my control? What are my options? Where do I want to go from there? If my plan A, if my ideal is not an option for me any longer, and so if you're planning for an unmedicated birth, know about an epidural and know that may seem taboo.
• I don't want you to think that.
• If you think about it, if you have these discussions, if you have this plan that you are somehow manifesting not having.
• Your unmedicated birth.
• I planned an unmedicated birth.
• I had an unmedicated birth, and I absolutely was open to an epidural.
• I knew all of the situations I would be open to an epidural.
• I knew exactly when I would ask for an epidural, and I knew what kind of discussion I would have with an anesthesiologist.
• Should I meet an epidural? And then if you are planning for an epidural, this is even more important for you to know.
• I want you to know the risk and the benefits of having an epidural.
• And I think that.
• Complications that can happen when your epidural is already placed is something that is not discussed a lot.
• Obviously, everyone has fear about becoming paralyzed or long-term back complications and back pain that may last years after having your epidural, which we do talk about in episode 4 0 4.
• But one thing that I think not a lot of people talk about and you deserve to know if you're choosing an epidural, is what happens if you run into complications with the epidural that's placed in your birth right now, in this time in space? And then how do I remedy those? And so I hope today's episode was helpful in laying out the three most common places that I see go wrong with an epidural and what you can do about those.
• All right you guys.
• I will see you in the next episode.
• Be sure to follow along on social media.
• You can find me at Tranquility by HeHe and at the Birth lounge.
• Until next time, head to your app store and download the Birth lounge app for evidence-based childbirth education and data-driven postpartum support delivered straight to your phone.
• Bye.
• Thank you so much for tuning in today.
• I love hanging out with you, and it is an honor to be your go-to gal when it comes to preparing for your baby.
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• You deserve to have a birth that you love with a provider that values your autonomy and respects form consent without all the trauma that you so commonly hear about on social media.
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• I'm Hei and this is the Birth Launch podcast.