Can't Have an Epidural? Let's Make a Game Plan!

If an epidural is not an option for you, it might be helpful to stack the cards
in your favor as much as possible.  It's time to make a game plan!

Here are my top 10 tips when you can’t have an epidural.

Tip #1 - Take a quality childbirth class.

Not a crash course, or one that happens to be at the nearest hospital. You need a well-rounded class that will help you understand all the tips listed below, as well as comfort measures. You need to know what to expect, the options available to you, how to cope, how to get baby into a good position, and get psyched to do this!

Do not skip this step. Even if you have taken a class before. There are many great childbirth classes out there. Do your research, talk to the instructor, and get a good outline of what they will teach. Don’t just take a class that is going to teach you how to breathe, or how to relax. While those things are great and even necessary, it will benefit you to learn many other hands on techniques as well.

Bonus points if your class will teach you the benefits of going natural (i.e, the hormones in labor)

Tip #2 - Hire a doula.

You're going to need someone to help you remember the stuff you learned in class.  Someone to help you get through this as fast as possible.  It doesn't matter how good your spouse is at helping you.  A doula is a professional.  She knows birth inside and out.  You're going to need all the support you can get.  Studies show that women who receive continuous support from a doula, are more likely to have spontaneous vaginal births, less likely to have pain medication, vacuum or forceps-assisted births, and their chances of having a cesarean were reduced! In addition, their labors were shorter, Pitocin augmentation was used less, and their babies were less likely to have low Apgar scores at birth.. --2012, Hodnett et al.

Bonus points if your doula knows spinning baby techniques, and has experience with unmedicated births.

Tip 3# - Scope out your hospital and your provider.

This is where your childbirth class and your doula will both come in handy. You need to make sure your hospital and your provider are familiar with natural birth. You need to know what pain relief options are available to you and are allowed. For example, do they have wireless monitoring available, tubs, showers, etc. What other forms of medication can they provide you? (See tip # 10). If you are planning a birth center or homebirth, then ask your midwife about the hospital you would transfer to, should that need to happen.

Bonus points if you do your research and find that the only hospital that will fully support your choices is an hour or more drive, but you are willing to drive that far, because you know how important a supportive environment will be!

Tip #4 - Use a tub or a shower.

This goes with tip #3. If you can find a place where you can labor in a tub, this might be your life saver. We don’t call it an aqua-dural for nothin’ :-) You may have to switch providers, and even place of birth, but if you can’t have an epidural, you may really want a tub available to labor and possibly birth in. If your hospital doesn’t have a tub, ask if you can bring one in (your doula or childbirth educator may have resources on where to get one locally). Try laboring at home in your own tub until active labor. 

Bonus points if your place of birth and your provider does waterbirths!

Tip #5 - Consider using a TENS unit.

When I am working with a mother who cannot have an epidural I ask her two questions: “Does the place where you are birthing have a tub?” and “Would you be like to use my TENS unit?” Obviously I am a huge fan, but you do have to meet the requirements and your provider has to be okay with it’s use too. I’m not going to explain what they are in this blog, but you can read about them here. A TENS unit may help you to relax and may help increase your natural endorphins (your natural pain killers). It’s best to start it in early labor, but if you skip that part for some reason, it’s still something in your bag of tricks that just might help you get a little further in labor without feeling the need to climb the walls.. I do suggest a TENS unit that is made for labor, as that has shown to have the best results. There are TENS units out there given to people from a chiropractor, or their physical therapist, and while they can help, it is best to use one designed (or preset) for labor. Unfortunately, TENS are not readily available everywhere, and as previously mentioned, you do have to meet the requirements to use one. I’ve not had a mom yet that needed to have an epidural-free birth, use the TENS and tell me that they would not use the TENS again for their next labor. Not everyone will love the TENs, but it's worth trying!

Bonus points if your doula is trained in TENS and double points if she has them available to use!

Tip #6 - Stay home in early labor, maybe even active labor!

Most women are relaxed when they are in their own familiar environment. It’s nice to be able to move around without asking permission, to lay down in your own comfy bed, to light candles and eat and drink as you’d like. Most hospitals and providers prefer women (who are in the low-risk category), stay at home until they are good and active anyway. Napping in between contractions helps you to reserve your energy for later, and it’s almost impossible to do this at the hospital where machines are beeping, and nurses are asking you a million questions - not to mention taking your vitals and messing with the monitors every few minutes. The more rested you are, the less pain you’ll perceive later. The more relaxed you are, the better the flow of oxytocin and endorphins - both of which you’ll need to have a faster and easier labor. Having a doula with you will help you relax and help you decipher when it’s time to head to the hospital or birth center.

Bonus points if stay home and relax until active labor, have a doula to help you at home, use a TENS unit, take a good childbirth class so you understand the stages of labor, utilize hydrotherapy (when not using the TENS), and choose a place of birth where they will be hands off if you do get their too early!

Tip #7 - Relax

Relaxing encompasses so many of the other tips listed her...having a doula, using the tub or shower, staying at home when possible, etc. If you can, use them all. Relaxing can also mean sinking in and letting go. Try tensing a muscle somewhere on your body right now. Now let it go, now try to get it to relax even more. Lay down and try that with your feet, your legs, your bottom, your back and shoulders, your face, your get the idea. You will learn how to do this in your childbirth class, and it will benefit you to practice.

Bonus points if you practice relaxation techniques on a daily basis.

Tip # 8 - Spin that baby.

Head down is half your battle, but it will also help if baby is facing the right direction. A posterior baby may cause a longer labor, and sometimes they have a harder time coming out. A good childbirth class and doula should be able to show you what causes this, and how to prevent it. A doula that is knowledgeable in spinning babies, is going to help you have a shorter labor, if you are able to do what she suggests. 30% or more of all babies start out posterior at the onset of labor...don’t think it can’t happen to you. If the doctor does an ultrasound and says baby is in a great position, don’t assume that he/she will stay that way. It can change on a dime. Continue to do what is necessary to keep baby in a good position! If you can’t have an epidural, the last thing you need is a longer labor :-)

Bonus points if you begin practicing and living these techniques at least 4 weeks before your baby may arrive.

Tip # 9 - Bring in extra support - but don’t make it a family reunion.

Throughout history, women have provided other women with support during childbirth. If you have a spouse, then I wouldn’t be surprised if they are #1 on your list of people who will be there to support you :-) The second person on your list, would be your doula. The third person is that extra woman in your life who will mother you. It might *be* your mother, but it can also be a close friend, relative or even another doula. Someone who will mother you, but can also be strong, and willing to provide an extra pair of hands, and heart. Imagine you leaning on your main support person, while your doula squeezes your hips. The third person can be grabbing the water for your to sip after the contraction, keeping the wash cloths cool, going for food runs - and doing whatever else needs to be done, so that there is no interruption of support. She is there to help the doula, to help dad, and to be the pintch hitter when dad needs to sleep, or the doula needs to rest. Most often, a doula can do all of those things without extra help, but in a long birth, it really does help to have an extra pair of hands ready to go. That being said, the laboring mom has to be comfortable with everyone in the room. If you can’t shower or pee in front of that person, then she isn’t ‘the one’. This person should also be ready and willing to leave (the labor room), at anytime the mother requests it. A person who feels watched in labor, or feels uneasy with anyone in the room, may actually take longer. This is why I say you should not make your birth into a family reunion. If there are people in the room who are watching the clock, or talking too loud, or are even just sitting there in the corner doing nothing but looking at their phone - it is a distraction to everyone. You support people will need a place to sit when they can rest anyway. Distractions slow labor, and well meaning comments can slow labor too, (like when they turn to the doula and ask “how much longer do you think this will take”?) Consider the type of person you are. If you are a very private person, then it might be best to keep your support to your spouse and your doula.

If you are birthing at home or in a birth center, make sure your support person is completely comfortable with this!

Bonus points if your support person has given birth unmedicated.

Tip #10- Know your options.

Narcotic pain relief, nitrous oxide, pudendal blocks*, sterile water injections etc are some other medical ways you might get some relief.. Depending on the hospital and provider, you might have more than one option for pain relief, should you really need it. This is where scoping out your place of birth will be helpful along with talking to your provider. If you are birthing at home or at a free-standing birth center, talk to your midwife about the options available at the hospital you might transfer to. There are some birth centers that offer nitrous oxide, narcotic pain medications, or both.

Bonus points if you can find a place with a provider that offers all of the alternatives!

* Pudendal blocks may be contraindicated in a mother with low platelet


Medical Disclaimer:
The information on this website and blog is meant for basic informational purposes only.
It is not intended to serve as medical advice or treatment. Readers are advised to consult with their doctor or midwife before making any decisions concerning their health.