There is a lot of research out there regarding the epidural and its role in childbirth. Do women who have them have a higher likelihood of having a Cesarean? Does their use increase the odds of tearing? Do they make labor happen faster…or slower? As you create your birth plan, these are questions you can research and I would strongly encourage each woman to discuss the answers with their care provider, childbirth instructor and doula. The vast majority of women in the United States do opt for epidurals as part of their plan, but most of them want the pain management aspect of the epidural and not an increased risk to themselves and their baby. Is it possible to have both?
Here are few suggestions for making the epidural a part of a birth plan, but that may help minimize any of the risks that are often associated with the use of epidurals during labor.
1. Hire a doula. Woman choosing to use an epidural need doulas as much as those who are choosing a natural birth. A doula will help you stay comfortable until you are able to receive you epidural. She will help you change positions after the epidural is placed that will encourage labor and she will continue to provide the relational support that defines excellent doula care. Epidurals usually are very effective at reducing pain, but they are not nearly as effective as reducing anxiety or providing support as a good doula is!
2. Stay home until labor is well established. Get in the tub, do something fun with your partner, facebook or really anything that is distracting and if all goes well you will arrive at the hospital in active labor and ready to receive an epidural. Your doula will come to your house if you would like and she can support you there there and help you determine when you want to head in to the hospital.
3. Check Position. If your baby is not anterior use gravity for a while to encourage a better position before getting an epidural. While waiting for the anesthesiologist, you can labor on all fours or standing up – both great positions to encourage a baby down and out.
4. Keep Moving. After receiving your epidural, ask your doula or nurse to move you into one of the many positions on the hospital bed that encourage the baby’s rotation and the progression of labor. Rotate these positions every 30 mins or so. This will help your baby move in the ideal position for birth. You might be surprised at all the creative positions that are available to women while they have an epidural!
5. Labor Down. When you reach 10 cm dilation, ask to labor down and have your epidural cut back. As it wears off you may feel more of an urge to push and hopefully laboring down will have brought baby down a bit so you will have less pushing to do. (Here is a great article by one of my favorite local OBs on laboring down.)
6. Take it Slow. Ask your care provider to provide perineum support and to guide you through pushing your baby out slowly. Tearing is more likely to happen when the baby’s head does not have time to stretch the perineum. If you and baby are happy and healthy you may ask your care provider if you may take it slow.
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Maria Pokluda has been a doula serving expecting families in Dallas and Ft. Worth since 2007 and has helped hundreds of 
families have happy birth days. Maria was voted “Best Doula” by DFW Child the past three years and has a special passion for helping couples achieve VBACs. You can find information about Maria’s services or read her blog at greatexpectationsbirth.com