As a note, I’ve been a nurse since 1997 and I’ve worked in labor and delivery for 20 year so I’m a great resource on this one, but always check with your provider before trying something new….

Oh, and I’d love to hang out with you during your pregnancy:

Is a Microwavable Heat Pack Safe During Pregnancy?

Yes! Somehow people think it’s filled with radiation from the microwave, but that’s not the case at all. I think those people don’t actually understand how a microwave works. You can learn more about them here. It’s not using radiation to warm things, so you can put that aside. You’re also safe to stand by the microwave as you heat your water for tea.

And most of ALL the food/heat pack does not hold onto anything bad once it’s out.

Which is great news, because a microwavable heat pack is actually my preferred method to use heat during pregnancy for a few reasons….

Reasons to use a microwavable heat pack in pregnancy:

Control the temp: You can easily pick what temperature you want the pack at by heating up for a specific amount of time in the microwave. So, if you just want it “warm” not hot — only do it for a minute or whatever. I think it’s smart to start with small #’s and then move up depending on the heat pack and your microwave.

It cools with time: The pack isn’t going to keep getting hotter as you have it applied, it’s actually going to cool down with time, which means you can fall asleep with it on (which, frankly is pretty frequent when those tight muscles chill out with the heat). An electric heating pad keeps pumping out the heat and can overheat you pretty easily.

Moldable: Since these heat packs are filled with small items (rather than an electric pad) it’s easy to fit them where you need it go to. Maybe on the sides of your belly for ligament pains, or whatever you need. It’s just easier to keep it OFF your belly — which is a big no-no — so let’s talk about what NOT to do with a microwavable heating pad (or frankly, any heating source):

Tips to Stay Safe Using Heat in Pregnancy:

Be sure to talk with your provider if you’re considering using heat for the aches and pains of pregnancy, but these are the general guidelines you can use.

Don’t use it over your belly — it can easily over-heat baby. While early in pregnancy this area has a lot of fat and muscle protecting baby, that won’t be the case as your belly grows. I just recommend not having the heating pad over your belly when you’re pregnant.

You can tuck it on the sides or low just over your pelvis, just don’t drape it across your belly.

Don’t use it for long — this rule is mainly for heating PADS but you don’t want to use it more than 30 minutes or so. It could make your whole body overheat which we know isn’t good for baby.

Don’t go HOT — you want to focus on WARM vs HOT at this point. Again, to prevent you from overheating over all.

BTW, heating pads aren’t ALL you need to worry about during pregnancy — so, grab my safe eating guide here:

Other Heating Options

A lot of people find a warm (not hot) bath to be very relaxing, or even a warm shower. Sometimes the shower is easier since you don’t have to hoist yourself out of it like you do the bath later in pregnancy.

A hot water bottle is always a good option as well. Since it has the same properties as to not getting hotter (and if you’re scared of the whole microwave thing that’s a good alternative). I don’t find them as moldable, so that’s the reason I prefer the microwave pad.

When can you use a microwavable heating pad in pregnancy?

I think heat is often under-used during pregnancy due to the fear of overheating during pregnancy. But, again — a microwavable pad takes a lot of those concerns out of the equation.

Ligament pain — When you have those stabbing pains on the sides of your uterus/belly heat can be used to help those angry body parts cool down.

Back or Pelvic Pain — Heat, again, can just help stressed-out muscles relax during your pregnancy. Remember that you’ve walked your whole life one specific way, but as your belly expands your body has to carry you in an entirely new way and those muscles are not a fan.

Early labor — I actually talk a lot about heat in my natural pain management bonus video in here because I think it can be really comforting to people in early labor.

So often pregnancy pains are dismissed as “normal” when something like heat can help you feel better, more relaxed and able to manage the aches and pains that come each day. If you have pains ask your provider what you can do to HELP them, so you can have a better quality of life!

Of course, some of the aches and pains of pregnancy are enhanced by all the “unknown” about delivery — so join The Online Prenatal Class for Couples where we’ll reduce your anxiety by over 50% and help you feel more prepared for your birth and life after baby!

And, if you’re not quite sure you’re ready for that whole thing, check out the free lesson from it. It’s your first step toward getting in the driver’s seat of your birth.

The post Can You Use a Microwave Heat Pack While Pregnant appeared first on Pulling Curls.

How do I know so much about cervical checks? — many people know me as The Pregnancy Nurse . I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. ​ I’ve performed thousands of vaginal exams (and stopped many doctors as well). A lot of women have this issue, and I’m excited to share some great info with you today!

Vaginal checks may be part of your third trimester testing — so grab my free lesson about that right here:

Looking for advice on just how to make them less painful? Click here and jump to just that part (skip the part on why they hurt).

Do Cervical Checks Hurt?

Most people find them uncomfortable, but some people find them downright painful. The way our bodies are made down there (and every person is different, I can testify to that) really changes how we feel them.

Combine that with history of sexual assault or other issues and it can be really bad.

If you haven’t had an exam yet (I have a post here on when they start) you should just plan that you’ll do fine with it (and some of the coping skills in here might help as well). If you go in expecting it to be miserable it likely will be — so go in with a neutral mindset and I think you’ll be glad you did.

But why are they painful?

Can You Refuse a Cervical Exam?

Pro Tip: At ANY point in time you can refuse a vaginal exam (and we’re going to talk about that in this post). However, at some point, you will likely need one. You can certainly lessen the number of them and make sure they are only doing them when necessary.

FYI, you can really refuse pretty much anything at the hospital, but there are consequences.

I have a whole video about them:

I also have a post on my sister site about when cervical exams start.

When you are wondering if you NEED a cervix ask you & your provider these questions:

• Will this change my plan of care (for example if they think you’re in preterm labor and need to stop if it if you are, or if you’re planning on an induction they need to know how to start it)
• Am I curious to know the results? (I’ll never shame you for wanting to know what’s going on with your body)

If it won’t change your plan of care, and you don’t really care as to what the results are you may consider refusing.

We talk about pro tip questions like this a lot in here so you can get in the driver’s seat of your birth!

Why do providers do vaginal exams During Pregnancy?

There are several reasons why providers do internal checks

Pap Smear/STD Testing — It is standard of care to do an internal exam at your first appointment, as well as doing a pap test (checking for cervical cancer) and STD testing. This is done as a speculum exam. Your medical provider will also likely check for any issues with your uterus, ovaries and fallopian tubes with their hands (called a bimanual exam).

Most often they do this smear test to check for cervical irregularities at your first appointment.

As STD’s can affect your baby as you progress in your pregnancy, this is important to be done (and treated if they find one). However, those are just the Q-tips and you can ask you provider to just check for those. Many providers do these as a urine screen as well.

Assess for Preterm Labor — With my last baby, I had an internal exam from 28 weeks on. They said they were checking for any signs of preterm labor. I have heard that in Europe this is the standard of care as your provider will be able to tell if your cervix is shortening (aka, preterm labor).

There is a condition where your cervix just can’t keep closed called cervical insufficiency where they can place a cerclage that basically sews it shut until closer to your due date.

In retrospect, I have ZERO history of preterm labor (nor did my mom) and I wish I would have said no. But, even labor nurses get caught up in the white coat…

Assess for Labor Progress — As you get closer to your due date (often around your 36-38 week appointment) your health care provider might assess how open your cervix is (called cervical dilation). However, these are pretty fruitless. Just because your cervix is closed today, doesn’t mean you won’t go into labor tomorrow.

If you aren’t interested to know what it is, these are easy to refuse at the end of your pregnancy.

If you are in labor for a long time they will likely need to do one to check for labor progress and decide if a cesarean section is necessary. While they do it, they’re also checking baby’s head and baby’s position to possibly rotate you to aid in baby moving down the birth canal.

Beta Strep Testing — Beta Strep is a bacteria that they have found can be harmful if the baby is born through it in the birth canal. So, they test for it around 36 weeks. It is just a Q-tip that is inserted into the opening of your vagina and rectum. It should not be painful and is very quick (some doctors let patients do this themselves).

Stripping Membranes — (also called a membrane sweep) this is a procedure that can be done to bring on labor (although the studies are pretty low for it). This is considered the most painful exam as they use their finger to separate the cervix from the bag of waters and many people find it quite painful (myself included). Read more about stripping membranes << in that article.

Absolutely ALL of these exams should include an informed consent. Providers are bad about saying “now I’m going to check your cervix” but it 100% in your right (and it should be done) to ask why they’re doing and what they’ll do when they are in there.

Assess for Your Stage of Labor — When you present to your provider thinking you are in labor they will need to do an exam to see how far along you are.

For instance, we have women in a LOT of pain who are only one centimeter — and would be much better to go home rather than to stay in the hospital. So, as nurses, we do need to assess where you are at when you first present to the hospital.

Or women who are in preterm labor might need an exam to see what their cervix is doing — if it’s opening they might need bed rest.

Some providers do routine pelvic exams your last week of pregnancy, but you can 100% refuse them (but some pregnant women really like knowing what their cervix is — and both choices are OK).

Assess for Vaginal Bleeding — If you present bleeding, they may want to do an exam to learn more about what is causing it (“bloody show” is not unusual when you are in labor). I have a whole post on bleeding at 20 weeks.

I will say a lot of women find the unknown the most scary — and that can even add to your pain! The Online Prenatal Class for Couples is the easy way to get prepared (just 3 hours my friends)!

Some people find they are in pain even after a vaginal exam << and I explain why in that post.

How do medical professionals perform a vaginal exam?

They can either use their gloved hands (usually two fingers) or they can use a speculum (that’s the duckbill shaped implement they put inside).

The speculum is most often used when they need to visualize your cervix (most often needed for STD exams and a pap smear, although we sometimes use them in pregnancy as well for other reasons — including telling if your water is broken).

During pregnancy, we use a sterile glove in the hospital to be extra cautious about extra bacteria in the vaginal canal.

Most often the doctor uses a small amount of a lubricant (like KY jelly) to make it easier on your tissues. Some tests can’t have a lubricant, they can sometimes use water though.

** Some delivery centers do them every hour (or in some time of regular stages) to make sure a patient is progressing. This isn’t the recommended standard of care (and also not how I routinely practice). If you find that your nurse is doing frequent exams just because it’s policy — that is a time to opt-out of that policy (which is fine).

Pro Tip: A lot of people think you can do your own cervical exam in labor. Reaching your own cervix can be hard when you don’t have a baby, and it’s even harder if you don’t know what you’re looking for. I never tried it as I didn’t want to pull a muscle reaching back there.

BTW if you’re wondering about exams, be SURE you’re doing your kick counts — grab my cheat sheet here:

When not to have a Cervical Exam

There are times that your healthcare providers will NOT do a cervical exam. Most often it is due to a risk of infection once your water is broken. Once your water breaks the bottom line is that your uterus is open to any bacteria in your vagina which can be problematic.

If you bag of waters (or amniotic sac) is intact, there isn’t to much of a medical risk reason to not do an exam.

I actually have a whole post on cervical exams at 36 weeks that explains more about this.

What do they learn from a Pregnancy Internal Exam?

I have a whole post on what the numbers from a vaginal exam in labor mean.

Mostly they are learning the position of the baby (is it head down?), how far your cervix is opened or if it is shortened (called cervical effacement)

Also the position of the baby in relation to your pelvis (or how low the baby is).

I think of your cervix is a thick tight-necked sweater that must stretch over your head.

I will say that vaginal exams have gotten a bad rap on social media in the past. A well-performed exam by an expert provider can actually tell us a lot about your labor progress and any interventions you may need during labor. It’s not just a few numbers, it’s a total picture of your pelvic vault/birth canal for your provider.

We combine all this information into something call the Bishop score that is an easy well to tell each other how ripe your cervix is.

Informed Consent for Vaginal Exams

Your provider will have a reason to perform a vaginal exam, and you should feel free to ask as many questions as you’d like before they do it.

You should also feel comfortable that the exam is necessary (I find that helps me feel better about any discomfort I feel during the exam).

Doctors SHOULD Be asking permission before they do something with your body. The end. It’s up to us to set this expectation with them.

Procedural Tip: Most often your provider will have a “chaperone” who comes in the room when they perform a vaginal exam. Often, if your spouse/partner is in the room, they can forego this (that just protects the doctor if you were to say that something inappropriate happened during the exam).

Related: If you’re thinking about exams, be sure to get that hospital bag packed too:

Why are vaginal exams painful?

I see several places online that say a vaginal exam should not be painful.

And guys — after 20 years in labor rooms (as well as having my own 3 children), I have to say that for most women this just isn’t true (especially with your first baby).

They can be very uncomfortable. They are intrusive, some women find them humiliating (but they shouldn’t). AND, for a lot of women they bring up powerfully bad memories.

I would think this is fairly self-explanatory. Your vagina is a fairly small opening, and while you do use it during intercourse, that has a lot of different feelings and emotions involved vs a check-up.

A lot of people have pain during their first few times with sex, so it isn’t unusual or different for you to have issues with the vaginal exam as well.

You may feel that the doctor is being unfairly rough but most providers are doing it with the utmost respect, but they do have a “job” to do. Sometimes in order to do that “job” it is uncomfortable for you. We do know that prolonging it excessively only makes it worse most often.

Frankly, slowing down the process doesn’t really make it less painful — it just makes it last longer. That’s something to keep in mind.

However, you can 100% stop them at any time if you feel too much pain. Always keep that in mind! It’s just a fine line between being an adult to get the information that you need vs managing your pain with it.

Vaginal infections (including yeast or bacteria) can make exams painful as well. You can always ask your provider if they think you have one of those if you find them intolerable — that could be an issue!

Vaginal Exam Anatomy Lesson:

As a note, women have three “holes” in their bottom/perineum area. There is:

• Urethra: The hole you pee out of.
• Vagina: The hole the baby will come out of.
• Rectum: The hole poop comes out of.

It is not unusual for women to not understand/know those 3 holes before — so I just wanted to clear it up. And yes, I talk about it in here in much more depth.

And I also have a whole post on avoiding pooping at delivery that talks a bit more about how these 3 holes interact at the end.

Something else to keep in mind is that first time moms tend to find the exams more painful than women who have had a baby. So, that’s good news for next time!

I love writing stuff like that down to remember next time. Which is why I made this pregnancy planner for you!

A quick soapbox moment: You don’t see men saying that their prostate exam wasn’t painful? No! They all dread and hate them, so when women say they hate exams we can support them by saying that they can be pretty miserable. No reason to chime in and say you love them!

Reminder: You CAN refuse

At ANY point in time, you can refuse a vaginal exam.

And, I am sad to say that many doctors don’t make this apparent. They just pull back the sheet and say they are going to check you (which is not informed consent).

I have a WHOLE (wonderful) podcast on how to say no in labor — but here are a few times it’s smart to say no to a vaginal exam:

• If you don’t see a reason for it — informed consent should make it clear why they are recommending it.
• You are waiting for your partner to come back to provide support.
• You would prefer they wait an hour.
• They are too painful and you simply don’t want to.

I also have a whole podcast just on refusing vaginal exams.

Keep in mind this can have consequences — and that there are times when you are in labor that you will likely need it done.

However, there are times that I see it done when it isn’t necessary, so I would encourage you to make informed choices with your team. Be sure to weigh the information you could get against the discomfort you might feel.

How to Make Vaginal Exams Less Painful

There are a few things you can do (and we’ll talk more about them below the list):

1. Learn some breathing techniques to help you relax
2. Push your bottom into the table rather than lifting up
3. Wiggle your toes (read on to find out more about that one)

If you love little tips like wiggling your toes to make it easier, there are tons more tips for labor, birth and postpartum in here.

Relax to make vaginal exams less painful

Sure, it seems totally impossible, but the more you tense-up the more painful it will be during your vaginal exam. It just makes the “hole” smaller and that is harder on you.

Try to breathe and try to think about all the positive things about being pregnant including that cute baby (and yes, I go over that type of breathing in one of the bonus videos in this class).

Press down to make vaginal exams less painful

A lot of women lift their hips UP during a vaginal exam (one doctor I followed during nursing school called it the chandelier reflex). This makes it harder and more painful for you.

If you push your hips down, it helps you to relax.

Raise hips to make vaginal exams easier

Sometimes, if you have a tilted cervix (and most people do in early labor) we will ask you to put your hips on your fists (or we will put a bedpan under you) This different position raises your pelvis. BUT you are still able to relax as you are putting weight on your fists, vs tightening your thighs/butt to raise your hips up.

Wiggle your Toes

I had a lot of people comment they wiggle their toes during the exam (I think it makes it easier to relax your pelvic floor).

Find a midwife

I do not recommend lay midwives, I do recommend a CNM (Certified Nurse Midwife)– one that can deliver in the hospital and has a load of training.

However, midwives are often more gentle and explanatory with exams. If you find that your doctor is too rough, consider finding a midwife to work with.

Discuss feelings/issues with your provider to make vaginal exams easier

Women who had forms of sexual abuse often find vaginal exams very painful. Besides the physical pain, it can also bring up emotional pain that they maybe haven’t processed.

Discussing these issues with your provider can be helpful for both of you. Sometimes, by them being specific about what they are doing and why they need to do it, it might help your brain be more at ease with the process.

**Moms of previous stillborns or even miscarriages often have feelings “swept” up during vaginal exams and that can be really hard too.

In all of those cases, we can’t help you unless you let us know — so be sure to talk to us!

Get some support to make vaginal exams less painful

By bringing in your partner, your mom or a good friend, they can help distract you some during a painful time. Some women find a doula very helpful in this case.

I have a podcast episode on what a good doula can do for you:

Some women just feel very awkward with a physician in this experience. I can assure you that it is not awkward for the provider and that it is just their “job” to do that day. Sometimes support can help you in that awkward time.

As you get towards the end of pregnancy, talk with other friends to see if they found it painful. Maybe you’ll realize you’re not alone.

And remember to go in with an open might. Will no one loves exams, many people find them to be very tolerable, and something to get over with (including myself).

What to do if vaginal exams are too painful?

While you can limit the number of vaginal exams (you are free to refuse them at any time) it is important that they occur:

• In the beginning to do a pap smear and std testing.
• In labor, to see how you are progressing (but this is limited, no need to check every hour or so).

Other times, you can talk to your doctor to find out if the procedure is very necessary. Refuse it, if you feel you can live with the consequences of not doing it.

BUT….

You need to remember that your baby’s head is much larger than the speculum or your providers’ fingers.

You are going to need to work on your personal coping skills to get through it.

Even if you plan to get an epidural, you will need to learn how to cope with pain before an epidural.

You will also need a vaginal exam after delivery to make sure that things are healing well. Along with your recommended pap smear.

I can’t recommend taking a prenatal class any more. This one will give you the tools to:

• Decide if you NEED an exam
• How to cope with pain (with it’s natural pain mangement bonus video)
• Know what to expect so things just aren’t as scary!

The good news about vaginal exams

The further along you get in labor, and life — vaginal exams hurt less.

• As your baby progresses down the vaginal canal, it makes it easier for us to reach your cervix, and makes it less painful — your cervix moves forward as labor progresses (remember as they progress into the canal you dilate more too)
• Your baby will stretch those tissues and with subsequent babies it hurts less.
• You learn to cope with the pain better — and contraction pain gets more intense (so the exam feels less painful)

So, that’s good news. It is rare that a second-time mom finds them as painful as they did the first time they had a baby.

Ok, time to get that prenatal class in. There’s SO much about pregnancy and labor that I can help you with if you just take the time to take the class. The meat of it takes just 3 hours, so you can do it! Come join me!

Not sure we’re a good fit check out my free class — It’s your first step towards being your own birth boss.

The post Painful Cervical Checks During Pregnancy: What to do if you’re scared. appeared first on Pulling Curls.

But how do I know so much about epidurals (great question, because you definitely don’t want to get this information from someone who has only seen a few births).  Hi, I’m Hilary — The Pregnancy Nurse®.  I’ve been a nurse since 1997 and I have 20 years of labor and delivery experience.  I’ve had thousands of patients on epidurals.  I’ve seen how it affects them both during labor and after we turn the epidural off — so I’m an expert on this one!

How long does it take for the labor epidural to wear off?

Normally it takes 1-2 hours.  

The epidural most often runs through a “pump” similar to an IV pump (you won’t see it “drip” though).  When you have your baby (or when they’re done with your repair) we turn it off.  We also remove the epidural tubing once you’re in a safe spot to have it removed (wondering more about the epidural injection and placement process — learn more in this post).

Pro Tip: The epidural is placed by someone in anesthesia — either an anesthesiologist or a nurse anesthetist.  Not by your obstetric provider or the nurse.

From there it really depends on how well your body processes the medication and removes it from your system.  That can vary in people but usually it’s 1-2 hours.

If you’ve ever been numbed at the dentist, this wears off similarly that the feeling will slowly come back (and if it takes a long time for dental to wear off for you, it might take a bit for the epidural to wear off too).

Most hospitals will try to get you up to pee within 1-2 hours after birth too.  If your legs aren’t steady enough they can use some devices that will help you get to the toilet without putting weight on your legs (we used one called Sara Steady that is sort of like a wheelchair with butt flaps).

It’s imoportant that you try to keep your bladder from getting full after delivery as it can increase your chance of bleeding (which is bad).

BTW, if you’re loving this “behind the door” look at labor rooms, come join me in here — TONS of info like this in there (and it won’t overwhelm you).

Can the epidural “wear off” during labor?

The epidural anesthetic is definitely not meant to wear off during labor.  BUT it can stop working for one reason or another.  It can be a kink in the catheter (tube), or it may have moved out of your epidural space.  The epidural provider will need to come in and assess how it’s working and decide what to do next.

I have a whole post on what to do if your epidural isn’t working.

Pro tip: Sometimes you have to get a bit feisty with anesthesia and tell them you want it fixed.  Sometimes they just say it’s “pressure” but if it is too much pain for you be sure to say that it is too much  and you need it fixed.  Just know the fix may be to be to replace it.

The epidural can actually be used in a C-section if necessary (although usually that is a spinal), so if they use the right epidural medication it can make you more numb or give you the pain management that you need.

While we’re here –grab my pain management options right here (because there’s more than just the epidural):

While the idea of the epidural needle again may not be exciting for you, remember they will again inject local anesthetic when you have it placed.  If you have a lot of labor left  — replacement of it may be will worth the pain relief the epidural during labor can provide.

As with anything communicating with your team so that you can get what you need is SO important — which is why I have a bonus video in here that talks about how you can talk with them. 

Sometimes being extra specific about what you’re feeling can help anesthesia figure out the problem too.

Remember, the epidural is really only meant to take about 80% of the pain.  You’re not looking for total numbness.  You still want to feel something so that you can move yourself in bed and push effectively. I have a whole post on the walking epidural that talks more about what you can ask for.  

If you have questions about the epidural please come join me in The Online Prenatal Class for Couples.  We have a whole chapter on the epidural, as well as one on natural pain management techniques that can help you mange the pain of labor well.  I even have a video where I go through the epidural process with Raggedy Anne Doll so it’s not scary, but you’ll know what to expect.

Or, if you’re not quite ready for the full class, you can grab a free lesson from it here — lots of great info about your final trimester in that lesson. Plus, you’ll be able to see if we’re a good fit for each other!

The post How Long Does It Take for the Labor Epidural Anesthesia to Wear Off? appeared first on Pulling Curls.

But, how do I know so much about this ring of fire? Hi, I’m Hilary. Many people know me as The Pregnancy Nurse®. I’ve been a nurse since 1997 and I have 20 years of labor and delivery experience along with 3 labor epidurals of my own. I have seen thousands of people birth their baby and have heard a lot about their experiences — so I think I’m an expert for you on this one.

Ok, so let’s first answer….

What is the ring of fire?

It’s a great name, right? It’s just what people feel as those final tissues of their vagina stretch. These tend to be the least stretchy as they involve your skin. As they stretch many people say it burns like crazy.

Many people just want to cross their legs and go home if they don’t have an epidural. BUT the only way around the ring of fire is THROUGH it as baby’s head stretches them.

Real quick — the epidural isn’t your ONLY pain management option in labor — be sure to grab my pain management options in labor:

Do you feel the ring of fire with an epidural?

Most often no. If you have a working epidural (I have a post on what to do if your epidural isn’t working that might interest you) you won’t feel it.

I do hear some people saying they DID feel it and two thoughts on that:

You may feel a lot of pressure.

The epidural doesn’t take away pressure (I do have a post on what you feel with the epidural). Even in the OR when we deliver a baby via C-section people will feel people pushing on their abdomen to deliver the baby. It just doesn’t take away that “pain”

You may have some bits of the ring of fire.

I have had so many patients say they felt it, but as someone who’s seen a lot of “natural” labor and a lot of epidurals most often they feel that pressure, and maybe some mild stretching, but it’s not the same.

There is honestly a special scream that a lot of women get in those final pushes if they don’t have an epidural — and I feel the ring of fire for them. Go ahead and scream, you’re just about there!

The good news is that once baby is out that ring of fire is immediately gone and you feel AMAZING. You just have to go through it…. much like a lot of life.

Does the ring of fire mean you’re tearing?

Not always. Most women feel it, first baby or 4th who don’t have an epidural on board. Some tear, some don’t. Remember I have some tips on how to not tear and also how to take care of your bottom after baby that you’ll find helpful.

Grab my postpartum checklist to make taking care of your bottom easy:

The thing is, if you know the ring of fire is coming it’s expected, and you know to push through it. The problem comes when people don’t know it’s coming and think something has gone wrong. Don’t be one of those people — now you know you HAVE to push through it.

Honestly, a lot of labor is going to be just like that. If you know what’s coming you’re going to feel SO much better. This is the easy way to get prepared. Even if you’re thinking, “Hilary — I’m too late for a class” — I really think you can fit it in and feel SO much more prepared! It honestly only takes a few hours!

Or, if you’re not quite ready for the full class, check out my free prenatal class — It’s your first step towards being your own birth boss.

The post Do You Feel the Ring of Fire With an Epidural appeared first on Pulling Curls.

But first, how do I know so much about epidurals? Hi, I’m Hilary — The Pregnancy Nurse®. I’ve been a nurse since 1997 and I have 20 years of labor and delivery experience. I’ve helped in thousands of epidurals (as well as helping patients after they’re placed) and I’ve also had three labor epidurals of my own — so I’m a great resource on this one!

What does the Epidural Feel Like?

The area may feel “numb” but most people feel like it feels “asleep”. They may still be able to feel their fingernail scratch their skin, but they wouldn’t feel it if they just brushed their leg.

A lot of people also describe it as “heavy” — and in this instance it often means that they can’t move their legs as well. Some people can’t move at all. Many won’t be able to hold their body weight with their legs (like lifting their bottom in the area), but most can still move their legs a bit.

This article is about what you’ll feel like AFTER the epidural has set-up. If you’re wondering what it feels like to get put in << check out that article.

The epidural is aimed to take away about 80% of the pain. While the epidural CAN take away 100% of pain/sensation from your bra-line to your knees there’s a few reasons we don’t want that:

• So you can move in bed on your own, that gives you autonomy and movement is an important part of labor (even with an epidural)
• We like for you to feel some sensation in your birth canal to know how/when to push.
• People generally don’t love to feel ENTIRELY numb and that can cause anxiety needlessly.

If you’re loving hearing about what to expect with the epidural come join me in here. I explain the whole process (with Raggedy Ann to make it less “scary”) and talk about all your options so you’re well prepared for pain mangement AND the rest of birth.

What if you want to feel less?

Some people have felt that the 80% was too much sensation for them. If that is the case let your anesthesia provider know. There are a few causes:

• The epidural tube may have moved and you may need it replaced (or it possibly never worked and need it replaced)
• You need more continuous medicine to cover the pain
• You may need a different drug to help cover it.

If you don’t feel like your epidural is working like you’d like it to make SURE you talk with anesthesia. That is an expensive procedure and you deserve to get the benefits. Be very descriptive about what you’re feeling (or have felt) to help them troubleshoot it the best they can.

Some people sometimes get a “window” of pain in an area of their abdomen that just doesn’t get covered by the epidural. Your provider can try more/different medicine but sometimes it just doesn’t get covered. It is a risk you take with the epidural.

If you’re wondering about your other options as far as pain mangement — grab my pain management — get that info here:

What if you want to feel more?

I feel like this doesn’t get talked about enough.

You can actually say you’d like LESS medicine. Maybe you’d like to move better in bed, or push better. Ask your nurse if she can turn-down the epidural medicine. She may be able to do it on her own, or she may need to call anesthesia about it.

I talked about this a bit in my walking epidural post on my sister site.

The beauty of an epidural run through a pump is that it CAN be tailored to just what you want. If you feel too much, she can up it. In fact, in the walking epidural often they give very little medicine early on and then up it as the pain gets worse. You can still ask for that type of pain management even if they don’t offer the “walking epidural”

When I say “walking” epidural I don’t want you think you can walk the halls. A FEW places will allow you to walk to the restroom, but most often just moving more in bed or getting into a chair. Most often your legs can’ thold you long even with that type of epidural

What you WILL feel with the epidural?

The epidural doesn’t take away pressure. So, sometimes as baby moves into your pelvis you’ll feel that. Some people feel some mild pressure with the contractions (but that shouldn’t be bad). Sometimes the pressure at the end can feel very intense and that can be hard to differentiate between that intense pressure and pain.

Even in a c-section with the spinal patients will often feel the pressure of the provider pushing firmly on their uterus to expel the baby — and that is very normal.

What about the Foley catheter?

Most places put a Foley catheter in once you’re numb after the epidural. Personally, I didn’t put it in if my patient could feel me (unless there was a big reason she need it). Wanted to make sure she was nice and comfortable before I placed it.

Most often I had to help her move her legs into position to place it and they felt nothing at all. They also didn’t feel it in-dwelling or when we took it out. So, in most cases the Foley catheter isn’t an issue for you.

When will I feel “normal” after the epidural?

Most people are able to walk within 1-2 hours. Some people need more like 3…. By about hour 4 most people feel back to normal entirely. However, every person’s body deals with the medication differently, so it may be different for you. That’s just what happens in MOST cases.

What did I feel with the epidural?

Personally, each one of my epidurals felt VERY different.

My first one I was as numb as could be (and my blood pressure dropped a LOT initially).

My second I had a window on my belly which wasn’t very fun. I also had to push a long time wtih a baby that was almost 1.5 pounds bigger than my first.

On my third I had one leg that was pretty numb for 12+ hours. I felt the baby drop into my pelvis and I thought she was going to shoot out my hip bone. It was pretty intense (but didn’t last long).

Same body, different anesthesia providers. Just don’t expect every epidural to feel similarly, it seems to be an art and not always a science.

I hope this peek into the epidural helped you understand it a bit more.

If you’re interested in knowing more about pregnancy, labor, birth and postpartum life in simple, easy to understand ways — come join me in The Online Prenatal Class for Couples. It truly is the EASY way to get prepared for ALL of that. I can’t wait to see you in there!

Or, if you’re not quite ready for the full class, check out my free prenatal class — It’s your first step towards being your own birth boss.

The post What Does Having an Epidural Feel Like? appeared first on Pulling Curls.

But, how do I know so much about epidurals?

First off, hello! I’m Hilary — many people know me as The Pregnancy Nurse . I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. ​ I have helped put in thousands of epidurals, along with having several of my own, and I’m happy to share my knowledge with you.

Grab my pain management options information here:

Quick tip: There are LOTS of types of epidurals. This article is going to focus on LABOR epidurals. If you’re looking on information on an epidural steroid injection you’ll want to look elsewhere (those are more often given for leg pain, back issues like a herniated disc, spinal stenosis etc).

Ok, let’s address the big question:

How long does epidural last?

It really lasts as long as we need it to. Best practice now is to place the epidural and infuse medication into it that helps numb those signals to the lower part of your body until we turn it off.

While there can be issues that arise that would stop it from doing that, that is our plan. I have seen epidurals last days, although our hope is that your labor is less than that.

But, it’s more complicated than that, so let’s keep talking.

What is an Epidural?

Some of you may want to entirely ignore this one, but it’s SO important to understand really what it is and what it can –and can not — do for you, so read this part!

Remember, epidurals come in many forms.  While we’re speaking to a labor epidural, a very similar process is also used to help other types of pain as well!

Epidurals are regional anesthesia (meaning it only numbs a portion of your body instead of putting you to sleep, or local anesthetic that only does a small area). Medicine is pushed in the epidural space (hence, the name) of your spinal column.

It is aimed to numb spinal nerves while help control pain (including labor, surgical pain, and chronic pain). Most often it is given sitting up, and your medical team will help position you for it.

Epidurals are most often given by a nurse anesthetist or an anesthesiologist — your pain management specialist.

Each of those will last for a different period of time, and are for pain management — but today we’re talking labor epidurals — how they work to numb the pain of contractions.

And yes, epidurals can seem really complicated, but I aim to really simplify them in here.

How is an epidural placed?

In most cases, an epidural is initially placed after about 3-6 cm of dilation (this post>> can tell you all about epidural placement, including how long the epidural needle is — and this post tells if an epidural hurts).

Are you afraid of the epidural or the pain of labor I recommend The Online Prenatal Class for Couples — it will prepare you for pain, and how you can manage it. I actually have a video where I place an epidural using Raggedy Anne.

Initially, they will numb the injection site. And then they find the epidural space (using an epidural needle).

After that, they will feed in an epidural catheter (a tube — it’s just about the side of spaghetti noodle, and is flexible) that will hang-out in your back until you’ve had the baby — and that replaces the needle.

That little tube (called an epidural catheter) will carry the medicine into your epidural space (which is not the same space your spinal cord is in) until we stop it or it gets pulled out.  It’s sort of like an IV in your back.

Some doctors do a combined spinal-epidural (CSE) that helps if you’re in a lot of pain when the epidural is placed. Which type of anesthesia they give you is based on the doctor’s preference (and abilities).

The doctor then gives you a large amount of epidural medication into that space — we call that a “bolus”.

The medicine is pushed in via a small tube in your back through a pump — very similar to how your IV goes into your arm. This makes it a very reliable method of pain control. The actual pain medication given in the epidural space does NOT last a long time, but we pump in new medication until we turn it off.

The amount of medication (and type), and how much pain relief you get is up to the doctor, for the most part. However, you need to speak up if you’re still feeling more than you’d prefer (remember they still want you to feel some — probably take away 80% of the pain).

Where does an epidural go?

To you, it will just seem like your lower back — similarly line as the top of your hip bones (but in the center of your back).

But, anesthesiologists place it between two of the membranes that cover your spinal canal (this is called the epidural space). It’s kind of like putting a needle into a banana and injecting between the peel and the fruit. That’s why it’s so important that you hold still so that they can do that very technical work.

How quickly does the epidural work during labor?

Most people have it take full effect by about 20-30 minutes after the complete placement (there is a good amount of set-up time after the provider enters the room). At this point it’s called an epidural nerve block as it’s blocking those nerves from giving you as much information about the pain in your lower half.

From there, the plan is for an epidural to last until we stop it, making for a positive birth experience.

That can go awry with things like the tube coming out of the right spot, or it gets kinked, but in most situations, it lasts until we stop it.

Can an Epidural “Wear Off”?

“Back in the day”, doctors used to just come in and give a giant amount of medicine every few hours (that’s how it worked when I had my first baby in 2000).  It didn’t drip into your back — but I would guess that all hospitals have it going in via a pump while you’re in labor.

This is one of those things that might be VERY different than when your mom had a baby. Make sure you take a class to be up to date on what to expect.

Causes of the Epidural “Wearing Off” During Labor:

There are things that stop the medicine getting to you though, and if you’re starting to feel pain your nurse and anesthesia provider can check:

• Is the pump still on and working (and not out of medicine — although the pump beeps like crazy once it’s out of medicine)
• Is the tube kinked — also pretty rare, this tube is firmer than regular IV tubes
• Has the tube moved out of the right spot in your back?
• Do you need more medication? They can give you more all at once, or increase the dosage on the pump.

Sometimes they can troubleshoot it with those things (often pulling the tube out a bit and re-taping it fixes it) but sometimes they do have to place a new epidural.

What You Can Do to Make the Epidural Last:

There are a few things you can do (and your providers will discuss all of this with you at the time):

Stay really still when they place it (that part is actually not very long, so it’s only a few minutes where you have to stay completely still) to make sure it’s just in the right spot.

Try not to drag your back across your bed when you move. Your provider will be a huge amount of tape around the epidural site, and we want you to feel comfortable moving your back (remember, the needle is removed once they get the tube in that spot). Just try not to drag it across the bed. Lifting it and moving place to place is better.

This all being said it’s not the worst thing in the world to have replace it. Most people say that the epidural placement is not as painful as the IV, and they do numb the spot well before placing it.

Can I get extra medicine if I need it?

Most pumps have a button that you can push for an extra amount of medication.  The pump is set to only allow you a certain amount of medication each hour.

If you are in a lot of pain, it is important you let your nurse/provider know so they can assess if you’re progressing or what is up.

Your anesthesiologist can also come in and give more/different medication if the medicine going in via the pump isn’t enough.  He can also turn the rate that the medicine goes into your back either up or down depending on if you’re feeling too much or too little.

**Sometimes we will turn off, or lower the rate for your epidural once it’s time to push so that you’re able to feel more. However, we can titrate it to make sure you still don’t feel a lot of pain when baby is coming out.

How often can you push epidural button?

Most places lock you out for about 20 minutes. So, even if you keep pushing the button, it will only deliver a dose every 20 minutes. This is to prevent you from giving yourself too much medication. An important safety feature.

Pro Tip: I WANT to know if my patients are in pain with an epidural so I can troubleshoot it. so, if you’re feeling like you need to push the button really often please do let you nurse know so we can troubleshoot it!

Can you still feel pain after epidural?

Epidurals are meant to take away 80% of the pain. Also, as baby descends into the birth canal that is pressure not pain — and the epidural will not entirely take that away. That can be uncomfortable.

Most people are very happy with a good epidural, but if you are still feeling more pain than you would like, talk with your team.

Remember it is important that you can still feel that pressure, and move your body with some assistance to help labor along. Hence, we aim for 80%.

I have a whole post on how much pain you’ll feel with an epidural.

Are there side effects to the epidural medicine?

Common side effects of the epidural anesthesia can be itching, a mild increase in temperature and clearly — numbness/inability to move their lower extremities as well as before.

There are other potential side effects (that are VERY rare) — and your provider may review them with you before the procedure.

Keep in mind that the MOST common side effect is your blood pressure dropping (which is why we give you a lot of fluids in advance), and that does NOT last long (as your body becomes used to the epidural medications and it not being in pain any longer).

You can also get a severe headache if the epidural block goes a bit far into the spinal fluid. This type of headache is very apparent and your provider can fix it with a blood patch. There are a few other rare complications and some serious complications your provider should go over with you before getting it.

If you’re on blood thinners there can be an increased risk, and other medical conditions can be problematic as well.

Keep in mind that the epidural is done in a separate spot than the actual nerves. So the risk of nerve damage is VERY small. Many women complain of lower back pain after having a baby (but it’s hard to separate that from the pain you might have from all your new tasks, the car seat, feeding etc.

** Your doctor should do informed consent explaining the risks and benefits to the procedure before placing the epidural.

Btw, if you’d like you thank your nurse, I have a whole post on gifts for labor and delivery nurses.

How long can you have an epidural?

In general, you could have an epidural for quite a long time.  It can infuse for days (I’ve never gotten to the point that we had to replace it), but it is best not to….

In general, we don’t want people in hard labor (hard enough to get an epidural) for more than a day…. Although it does happen.

There may be hospital policies (likely due to infection rates) that an epidural can only be in for a certain number of hours and then must be replaced. But, because an epidural is followed closely by either a doctor or a nurse anesthetist (and done sterile-y) this shouldn’t be too much of an issue.

If you have any questions about that you can always ask your nurse about your particular hospital (I’ve never had one of those policies at my work).

How long does it take for epidural to wear off?

The epidural usually takes 1-2 hours to wear off after we turn-off the medication and/or remove the tubing from your back.

Most often we turn it off after the doctor has the placenta out and is done with any repair needed, and we remove it once you’re in a position to have it removed (I don’t want to interrupt skin to skin to remove it if possible).

Your legs may still feel a bit weird that first time you get it. Make sure you hold onto your nurse and take her help the first time you get up.  All of that is totally normal!

How long does an epidural last after a C-section

Most planned C-sections have a spinal, although if you have an in-dwelling epidural they may put in a lot of medicine to get that to work the same way.

Those epidurals will wear off slowly — and last to their full effect about 2 hours (where you can’t move your legs at all). It slowly wears off after about 2 hours — sort of moving up your body. Your abdomen will have the epidural last the longest, so that’s a total perk of spinal or epidural anesthesia vs general anesthesia. 

We usually leave the urine catheter in for 6-12 hours after the surgery and we often will sit you on the side of the bed when that comes out. Prior to then it would be really hard to get up and walk as the spinal is still wearing off.

I also have a post on what to take to the hospital for your C-section.

What should you not do after an epidural?

Other epidurals that aren’t for labor have specific recommendations for what to do (or not do) afterwards. But, because you just had a baby most of those rules already apply. No heavy lifting, and try to get plenty of rest — all of which will just happen after you have your baby in the hospital.

Unless something really rare happened, no special precautions are given if you had an epidural in the hospital. You’ll go home just like someone who had a “natural” birth.

Which is better — epidural or natural birth?

Every woman and every labor is so different.  Never has this advice been more pertinent — you do you.  Do what works for you.  You can’t compare your labor or your pain with anyone else’s.  After almost 20 years in L&D I can guarantee you that.

BUT, let’s answer this one that gets a lot of questions:

When should I get my epidural so that it doesn’t wear off before I have my baby?

Hopefully, you understand that it should last through labor if done properly, and nothing messes it up. I do have the answer to when I think you should get it right here:

Most often we recommend you not get it until you’re well into active labor (I go over the phases of labor in this post)

So, that’s that — in general, you don’t need to worry about the epidural wearing off before you have your baby — but remember — an epidural isn’t meant to take away ALL labor pain << read that post to find out why.

AND if you’re interested in more info on pain management during delivery be sure to check out my Online Prenatal Class for Couples.

• Accurate — you’ll get the RIGHT info.  Since I still deliver I really know what I’m talking about
• Engaging — so many couples call it “fun” — which I love!
• Budget-Friendly — pick the price point that works for you, it’s the best-priced class online!

Or, if you’re not quite ready for the full class, check out my free prenatal class — It’s your first step towards being your own birth boss.

The post How Long Does an Epidural Last? appeared first on Pulling Curls.

First off, hello! I’m Hilary — many people know me as The Pregnancy Nurse . I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. ​ I’ve talked to thousands of people women about the aches and pains of pregnancy — and I’m a good resource on using heat to help with it.

If you’re looking for tips and tricks for making pregnancy (and labor) easier, check this out.

Heating Pad While Pregnant

This is part of my Labor Pain Management series — and the great thing about heating pads is you can use them during your pregnancy, as long as you follow some guidelines…

Pregnancy certainly has a lot of aches and pains associated with it.  The big question here is — CAN you use a heating pad while you’re pregnant and what can it help?

How Does Heat Help Normally?

Heat treatments allows tight muscles to relax. It is a side-effect-free (normally) way to ease those aches and pains and help your body re-align itself.

While it doesn’t always take the pain away entirely, it does help “take the edge off”. It is just a temporary relief from pain, but welcome nonetheless.

As always, please take the advice of your provider over my advice, as they know more about you and your individual circumstances.

What type of heating pad to use while pregnant?

Because pregnancy has its own set of issues, I prefer to use a microwaveable heating pad. You can also use a hot water bottle. These are safer alternatives (don’t worry, we’re going to talk about why).

You are in a bit more control of the temperature vs an electronic one and a microwavable one cools with time, which makes it a bit safer (because often you’ll fall asleep once it helps you relax).

Keep in mind, appropriately used heating treatments can often be safer than medication. It’s a very simple solution to many pains pregnant women have — just be sure to know where you’re using it is with your provider’s OK.

And yes, there have been studies that raising the heat of the unborn baby can cause neural tube defects & other birth defects, which is why they don’t recommend very hot baths, use of hot tubs or saunas during pregnancy. Long periods of using a heating pad can cause your core temperature to rise to a problematic state. The good news is there are other good alternatives that won’t cause a high temperature.

However, heat applied to one part of your body (especially when not directly near your baby — or draped across your abdomen) won’t raise your whole body temperature to unsafe levels.

However, if you use a water bottle or a microwavable heat pack — you can use them for a long time (aka, if you fall asleep) as they will cool with time.

ACOG which is the OB’s professional practice organization recommends heat for back pain, but says you should limit the time heat is placed (which is why I prefer the microwaveable vs electric ones). You may want to consider using the heating pad on the lowest setting.

The big thing is to not raise your core body temperature (so just a small area, for short periods of time), and you don’t it touching areas where the baby is — so across your belly.

Most manufactures don’t recommend long time use of a heating pad at the highest setting and there have been documented skin burns from using it that way.

Also, make SURE you’re staying hydrated during your pregnancy. I even have a related post about if you can drink Gatorade during pregnancy. I also have a post if you have belly button pain.

Can you use a heating pad on your belly when pregnant?

I don’t recommend using a heating pad over your belly while you are pregnant. 

We’ll talk a bit more where about where you CAN use it on your belly, but draping it over your belly isn’t a great option for a few reasons:

• If you’re really cramping like you need a heating pad and you’re before 36 weeks, you should talk to your doctor — if you aren’t sure where the abdominal pain is coming from, you need to talk to your provider.
• It will heat up the baby as they really aren’t far from the surface and don’t have too much protection between them and the heating pad.

If you want to use a heating pad on your belly, I would certainly talk to your health care provider before doing so.

Where can you use a heating pad during pregnancy?

I am a big fan of using it (and by it, I mean a microwaveable one vs an electric one) a few places:

• In your ligament area (that’s more in “corners” of your belly vs. directly on top of your belly — you can read more about round ligament pain in this post on normal pregnancy symptoms).
• Back pain, you can lay on the heating pad (or use it behind you in a chair).
• Sometimes leg cramps can be really annoying and heating pads can help relax those muscles in specific areas (although being mindful of your hydration as well as vitamin intake can be important in those as well — talk to your provider!)

Keep in mind that the vast majority of pregnant women do experience back pain during pregnancy, so you aren’t alone in trying something to help!

How can a heating pad help during pregnancy?

You’re using the heat to help relax tense muscles — which is a good idea!

Using a heating pad for ligament pain in pregnancy

• Use light heat — you don’t want to use your microwaveable pad to be too hot. It should just feel warm to the touch.
• Tuck it into the corner that hurts — as little as possible should be touching your belly.
• Do NOT use an electric heating pad — use a microwaveable one — as it gets less hot with time and is easier to “tuck” into spots.

Pro Tip: Since microwaveable heat packs don’t have a heat source they slowly cool and can be safer vs one that the heat is constantly being “fed’ to it.

The graphic above shows where your ligaments are that usually hurt (they’re actually called your “round ligaments” — and they hold your uterus onto your body, and they are stretched a LOT as your uterus grows.  They can also hurt more:

• When you stand quickly.
• When you lay down quickly.
• Cough or sneeze.

One thing that can help ligament pain is making sure your belly is supported when you sleep on your side (use a pillow underneath it).  I talk more about ligament pain in my normal in pregnancy post.

Also, pregnancy belly straps may help this issue as well!

Make a pregnancy heat pack

• Get a dishtowel (buy one or use an old one).
• Sew up the majority of the sides, leaving an opening to add the beans/wheat/rice — which you add now.
• You can also add essential oils if you like those smells and they relax you.
• Then sew up that hole.

Start with 1 minute in the microwave to see how warm it gets, then add 30-second increments to see how long your pack will tolerate. I wish I could give you a good rule of thumb for how long to heat it but it really depends on what is in the pack and how your microwave heats.

You want it warm, but not too warm so that the towel/rice burns (done that!) or is too hot for you to pick up and handle.

I talk about the best ways to use a microwavable heating pack for labor pains in here (the natural pain management bonus video).

Heating Pad During Labor

Some women find heat comforting during labor. Remember:

• Still don’t use it draped across your belly.
• Don’t use it for extended time periods.
• Consider a hot water bottle too if a microwave isn’t convenient.

Heating pads are one of the most common tools doulas use and they can help a lot as you labor at home.

You may also be hot due to increased blood flow — just use it if it feels good.

Common Questions About Heating Pads During Pregnancy

Can you use an heating pad during your first trimester?

Again, I would not use it across your belly, but ligaments can ache as your uterus grows.  You can also use it on your back (especially your lower back pain), or another affected area for pain relief.

However, if you’ve already done it — keep in mind in early pregnancy you have a thick uterine wall, as well as muscles and fat to cushion your baby against any heat. While I wouldn’t do it, if you’ve already done it it isn’t too concerning.

The main thing, especially in the first trimester — is not raising your core body temperature with an electric heating pad. Baby does best when they grow at your regular body temperature (which is part of why they don’t like fevers in the first trimester when baby is growing important parts).

I also have a whole post on when your belly will start to get hard in pregnancy.

Can you use a heat pad during your third trimester?

Your baby REALLY doesn’t have much protection from a warm pack across your belly at this point — so be sure NOT to use it across your belly as it will heat your baby and stress them out.  But I recommend it frequently for back or ligament pain when placed appropriately.

Is it ok to use a heating pad on lower abdomen while pregnant?

You don’t want to lay it directly across your abdomen, but I usually recommend you tuck it below the uterus. Often one side will hurt due to ligaments and heat can help those relax. I like one like this that you can use OFF your actual belly or where the baby is.

How long can I use a heating pad on my back while pregnant?

You definitely don’t want to increase your core temperature due to it. You’re wanting to use it in specific areas for 20-30 minutes and then let the area “air” out — but the good news with a microwaveable heating pad it slowly cools, because you often will fall asleep if it’s helping you relax while it’s on.

Can you fall asleep with a heating pad while pregnant?

I never recommend falling asleep with a heating pad during any point of your life, unless it is microwaveable (one of the big perks to using a microwaveable heat pack — as it cools with time).  It can over-heat your body and can be problematic (including fires).

Heating pad for pregnancy back pain

Heat therapy can be AWESOME for that.  I would be more willing to use an electric one on my back vs near my belly but I would still be cautious (and don’t fall asleep on it). I would limit it to under 20 minutes at a time.

Also consider your body mechanics and work on your posture during the day, it might help. Consider ditching the high heels, and wear something that gives good arch support.

You can also consider using heat packs for joint pain, sore muscles (not your abdomen) or muscle spasms, as well if you have an injury, etc.

Other things to consider for pain during pregnancy

A lot of the aches and pains you experience during pregnancy are totally normal, but I would certainly discuss them with your provider to make sure you’re still good to go.

Other things you can do (under the care of your provider):

• Prenatal Yoga (there are some poses you shouldn’t do while pregnant, so be thoughtful of that).
• Regular mild exercise can help.
• Mild stretching.
• Pregnancy support bands (like this).
• Pain medications (like Tylenol) — there are options depending on how far along you are in your pregnancy — talk to your provider.
• Warm bath (not hot) or shower — remember avoid high temperatures.
• If heat isn’t working for joints, you can always consider an ice pack (but again, I wouldn’t place it over your belly — your baby will notice).
• Using a body pillow to support you during pregnancy sleep — like this. Or if you just have an extra small pillow, put it under your belly or between your legs when laying on your side.
• If pain is really an issue, consider seeing a physical therapist or a chiropractor, there are things they can do to help!

I am a big believer in giving your baby the most neutral environment to grow during your pregnancy, so the less you can use medications and even heat, the better.  Before you know it, your body will be back to being your own and you’ll be able to do what you please — but during those nine months, be thoughtful of what you can tolerate.

Obviously — there is a lot to think about when considering both your’s and your baby’s health. That’s why I really recommend a prenatal class. Things can feel really complicated, but this one really simplifies things for you!

Or, if you’re not quite ready for the full class, check out my free prenatal class — It’s your first step towards being your own birth boss.

The post Using a Heating Pad While Pregnant: Can you use it on your stomach? appeared first on Pulling Curls.

This episode was inspired by my posts on epidurals: https://www.pullingcurls.com/?s=epidural

Big thanks to our sponsor The Organized Home Family Routines The Online Prenatal Class for Couples

Mentioned in this episode:

My Youtube video on the epidural placement is here: https://www.youtube.com/watch?v=xrd0AzxySH4&t=262s

Other things that might interest you:

Producer: Drew Erickson

Check out my other pregnancy podcasts:

Transcript

[00:00:00.090] – Hilary Erickson

Hey, guys, welcome back to the Pulling Curls Podcast. Today on episode 174, we are talking about being afraid of the epidural. Let’s untangle it.

[00:00:19.540] – Hilary Erickson

Hi, I’m Hilary Erickson, the curly head behind the Pulling Curls Podcast: pregnancy and parenting untangle. There’s no right answer for every family, but on this show, we hope to give you some ideas to make life simpler at your house. Life tangled just like my hair.

[00:00:40.460] – Hilary Erickson

The epidural is something that people are honestly super afraid of. I will say that a lot of my patients and honestly, I think even me, gets real shaky when anesthesia comes in because they’re just nervous about it, right? They think it’s going to be a huge deal. And I will say most of my patients find that it was not near as scary as they were anticipating it to be. So today I wanted to give you four tips in case you are afraid of the epidural that might help you for it.

[00:01:10.310] – Hilary Erickson

Do you feel prepared for your delivery? In just three short hours, you can be prepared for the confident, collaborative delivery you want. You’ll know what to expect and how to talk with your health care team. And there are no boring lessons in this class. I’ll use humor stories from my 20 years in the delivery room to engage both of you. I love how Alyssa told me that she found herself laughing at things that used to sound scary. Most of all, you guys are going to be on the same page. From bump to bassinet, join the online prenatal class for couples. Today you can save 15% with coupon code UNTANGLED. You can find the link in the show notes.

[00:01:45.340] – Hilary Erickson

The first one is to know how normal it is to be afraid of it. I have so many patients who apologize because they’re shaking or they’re embarrassed by it. I mean, I am a labor nurse and I get a little nervous when I go in to do an epidural. It’s just a lot of unknown. You’re worried.

[00:02:00.010] – Hilary Erickson

We are biologically programmed to be very protective of our backs, so it would be very normal for us to not want anything to hurt it. So nurses understand that you’re nervous and that we are there to help support you. So I think that’s one of the best tips to know is that it’s normal and your nurse is used to helping people confront their fears and get through the epidural process. The second thing is that you literally cannot see them put in the epidural. I know a lot of people are like, “don’t let me see the IV.”

[00:02:27.240] – Hilary Erickson

Some people want to look at the IV, but most people prefer not to look at the IV. But with the epidural, you literally can’t unless you’re like in the exorcist and your head can turn all the way around because where they are putting the needle is just not somewhere that we can see. So if that’s a concern, of yours. Most often you never see the epidural. I know they can be scary to see.

[00:02:46.410] – Hilary Erickson

If you’ve seen one online, let me be very clear that that entire needle is not going in you. I have some patients that I think that needle would have gone all the way through. The needle is big so that you have a little bit more play as you’re putting it in. That’s the only reason that the needle is bigger than something that you might normally see so you can’t see it and sometimes that’s comforting for people. The third thing is to learn the process.

[00:03:08.460] – Hilary Erickson

Now guys, in the show Notes, I’m going to link a YouTube video that I did that I show the entire process using a raggedy-ann doll and I go through everything like how they clean your back and that might feel cold, how they numb it and that might feel bee sting. You’re going to learn the whole process. So I would 100% recommend checking out that video. I just use mostly like household items. A few things I bought on Walmart to just show you what to expect. That’s a good one to find out as well.

[00:03:35.160] – Hilary Erickson

Now the fourth one apparently really varies hospital to hospital. Every hospital that I’ve worked at, the partner was allowed to stay. Then during COVID I heard some partners weren’t allowed to stay because anesthesia was concerned that they would catch COVID from the partner, even though anesthesia has always been masked during the procedure. Now you have to remember that the epidural is really important that everything stays sterile because we obviously don’t want to introduce bacteria into our spinal fluid.

[00:04:01.410] – Hilary Erickson

That would be really bad. Infection would be one of the things we’re really trying to prevent in the epidural placement process. But most often, and you can check with your hospital, ask your provider, they might know your partner can stay in the room. And one of the things I love to do is set up the partner in front of the patient because most partners have to sit down for the epidural placement. Anesthesia generally doesn’t like the partner looking at what they’re doing.

[00:04:24.480] – Hilary Erickson

And we’ve had a fair number of partners faint, so we want them to be seated because we can’t be dealing with the birther, having the epidural and a partner fainting. So make sure you maybe have eaten something before the process as well. So the partner I like to sit in front of mom and then put the birther’s feet on the partner’s legs so they raise the bed up. And then when we put your feet on their knees, it helps curl your back and you feel super supported and the partner feels like they are involved in the process as well. So that’s one of my favorite things to involve the partner help position.

[00:04:55.930] – Hilary Erickson

It’s less work for me. So I really like to involve a partner. I would encourage you that if you’re really worried about the epidural. Mention that to your partner so that they can be extra attentive and supportive during this time. And maybe you can watch that video together that I will link in the show notes. If you’re like, “I don’t want to find the show notes,” My YouTube channel is the Pregnancy Nurse and if you just type in epidural procedure, I believe it should come up and you’ll see a picture of me and my raggedy-ann doll. So it is pretty, not scary, but it will give you an idea of what’s going to go on. And I think if you understand what’s going to go on, you’ll really be okay with the epidural process. That’s epidural.

[00:05:29.050] – Hilary Erickson

This one’s kind of a short one this week, but I want you guys to understand that it’s normal to be nervous about it. Most people find that it was much better than they anticipated, although I’m nervous every single baby. I’ve had three epid…. Actually I’ve had more epidurals, but that is a podcast for another day because FYI, they do put in epidural for pain relief or back and stuff. Mine was for tailbone pain.

[00:05:48.700] – Hilary Erickson

If you want a podcast on that, tell me on Instagram. But anyway, the epidural, it’s not so bad. If you have any questions, come find me on Instagram. I will have a post that relates to this podcast episode and I would love to chitty chat with you over there.

[00:06:00.910] – Hilary Erickson

Stay tuned for or upcoming episodes. We have one talking about starting decluttering when you feel overwhelmed, which is so normal, just like both of these things are very normal, epidurals and decluttering. And then I’m going to actually have a replay, so stay tuned for which episode I thought was a favorite.

[00:06:17.010] – Hilary Erickson

Thanks so much for joining us on today’s episode. The Pulling Curls Podcast grows when you share us on social media or leave a review. If you do, please tag us so that we can share and send you a virtual hug, which frankly is my favorite kind of hugging. Until next time, we hope you have a tangle free day.

The post 4 Tips if You’re Afraid of The Epidural — Episode 174 appeared first on Pulling Curls.

First off, hello! I’m Hilary — many people know me as The Pregnancy Nurse . I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. ​ I’ve helped with thousands of epidurals and I know exactly what you should expect from epidural anesthesia pain relief during labor.

If you’re worried about the pain during labor, grab my pain management options right here:

Why Does Labor Hurt?

Labor pain comes from your uterus contracting.

Just like when you’re carrying 12 bags of groceries up 3 flights of stairs — your bicep hurts, so does your uterus.

What does labor feel like?

Contractions (that cause a painful labor) start as cramps and then progress into more painful contractions.  They feel very similar to horrible stomach pains that never let up.  They are manageable — but many women ask for epidural anesthesia. In the US it is available at most hospitals.

How Does the Epidural Help with Labor Pain?

Modern epidurals place a tube (we call tubes catheters in the hospital) into the “epidural” space in your back — it is fed through the epidural needle. The epidural is administered by either an anesthesiologist or a nurse-anesthetist — not your OB or midwife.

That’s a very technical spot between the “duras” which protect your central nervous system (brain & spinal cord / nerves). The dura are membranes. That’s all it means. One of our doctors said it’s like placing the tube between the banana fruit and peel of a banana. That’s a pretty good picture of it all.

When they inject pain medication (it is similar to the local anesthetic they inject you with at the dentist) in your lower back area, it helps to numb those nerves and take away pain. Epidurals are used in many procedures including:

• Surgery, especially orthopedic
• Pain relief, you can get an epidural injection for back pain, leg, or hip pains.

We now frequently use the epidural for pain relief in labor and delivery.

History Lesson: Your mom might have had several injections with her epidural (I did with my first in 2000), but we now use a pump and the medication is fairly steady. Gotta love advancements in pain medicine! The pump can increase or decrease the amount of medication, so it’s really tailored just to you!

How is the epidural placed?

I have a whole post on epidural placement that details the entire process.

One of the most important things to know is that an epidural is placed by an anesthesiologist (or CRNA, which is like a nurse practitioner of anesthesiology) — not your OB.

I also have a video on how it is done that you can watch on Youtube:

Does the Epidural Hurt?

Getting the epidural can be a bit uncomfortable for a few reasons:

1. Positioning — they need you to sit up and curl your back over in order to get the epidural. Some people don’t like how still they need to sit or that position they need to hold to get the anesthesia.
2. Numbing injection — they inject medicine (Lidocaine) to numb the area before the epidural — most often this feels like a “bee sting”
3. Pressure on your back during placement. Since the “pain” is taken away during the placement, you may still feel some pressure during it as they find the right spot.

In general, once you receive an epidural you may feel cold. The tape may tug at your skin, but most people aren’t bothered by it at all after the placement.

Are there different types of epidurals?

Many of you may have heard of the “walking epidural” — which, is mostly an epidural that has less medication given and allows you to be able to put SOME pressure on your legs. However, as this is also less effective, most providers don’t give it.

And even if they do, you aren’t able to like fully walk around the hospital. You may be able to get up and into a chair.

Some providers place what’s called a combined spinal epidural (CSE) — where they initially place medicine in your spinal area and then pull back the needle and place the tube where medicine will continue to go in your epidural space. This offers great pain relief initially, however not every provider is trained to do it (and especially do it well).

The best epidural type is the one that your provider is proficient at and believes will give you the best pain relief.

Does labor still hurt with an epidural?

The epidural is pure magic.  At least, that’s what it seems like to me — on the other side of the patient.  

Yes, there is a lot of effort and schooling that have gone into your anesthesiologist to put it in, but once it’s in it should make you fairly numb from about your bra line to your knees.

But it can differ during your labor.

How much pain of contractions does the epidural take away?

Notice above, I said “fairly”.

Yes, you’re still going to feel pressure, some sensation and when done correctly — it will not make you entirely numb.

You read that right — it will NOT make you totally numb.

Yes, you’re paying thousands of dollars for that epidural, but…

It is likely that the epidural will cover about 80 percent of your pain in your lower body when done right.

Why we don’t want the epidural to entirely numb you:

1. We still need you to move around a little bit.  It’s still important to move from side to side and be able to assist in positioning yourself.
2. You need to feel pressure to feel when the contractions are happening — that helps you know it’s time to push.
3. That pressure helps you push better and can help decrease your pushing time.  If you’re ENTIRELY numb, you aren’t as able to push.

Pro Tip: you should still be able to move a bit with an epidural — if you can’t move at all, you may want to talk to your providers to decrease the rate.

Of course, pressure can feel very much like pain.  I can guarantee that the pain you’re feeling is much less than it would be if you didn’t have the epidural, even if you find it very painful.

What does labor feel like with an epidural?

Contraction pain should be 80% lessened with the epidural.

In fact, because they give you extra medications when they start the epidural it actually goes down QUITE a bit in the beginning, and then that 20% comes back once that inital “bolus” of medications wears off.

Most women don’t feel cervical exams much after the epidural either (btw this post has tips for painful vaginal exams).

Also, a foley catheter is required after an epidural, and most people don’t feel that at all either.

That being said, they may feel achy on one side or another as the epidural moves with gravity. If that is the case, your delivery team will rotate you as needed to let gravity affect the other side as well.

Some people do have spots that it doesn’t take, but most people are VERY comfortable with an epidural — and after feeling 100% of the pain, are very glad to take 20%.

Note to remember: You can not plan on the epidural to make you entirely numb. Plan on some pain as your labor progresses as we have found that to be the best plan for laboring mothers. Painless labor isn’t what we want, and you shouldn’t want it either for the reasons mentioned above.

Does pushing hurt with epidural?

It initially feels quite odd. It’s hard to do anything when half of your body is numb. However, pushing out a baby is exactly the same as being very constipated on the toilet (with admittedly much cuter results). Your body quickly realizes that and gets to work.

Pro Tip: Learning about pushing in advance can be super helpful, and yes — it is covered in here.

Can you feel baby coming out with an epidural?

You most likely won’t feel the “ring of fire” that a lot of women experience without pain management. However, as I said above — we can’t take away “pressure” and there is a LOT of pressure in your pelvis and on those tissues as baby comes out.

Those last few minutes of pushing can be a bit uncomfortable, but some women have very little pain during that as well, so it just depends.

Do I have any control over how numb I am?

Yes! Most hospitals allow patients to have a PCA machine for their epidural administration, which means you can push a button to get more epidural medication.

However, I don’t give my patients that button.

Hahah — it makes it sound like I am mean, but I want to know if my patients are in pain so I can properly assess them (and then help them push the button).

Sometimes you’re in pain because the baby has descended and we need further interventions, etc. As a labor nurse I use pain to help me assess how things are going, if you just keep pushing your button, I never know that.

The other good thing about the PCA machine is we can turn up or down your “base dose” (the machine pumps in a certain amount just like an IV — when you push the button it gives an extra dosage) to make sure that you can move/feel like we need you to. We can really tailor the experience to what your body needs!

Sometimes we need to turn it up as labor progresses or turn it down if you can’t feel your contractions at all during the pushing phase.

Does an epidural slow labor?

Studies show it does slow the pushing process. This is because most often we allow the patients to rest and let their body bring the baby down vs an extensive pushing time. Not that you push for much longer with an epidural.

Also, as I said before, it usually takes a few pushes for patients to “get the hang of it” when they start pushing with an epidural, which may extend pushing time a bit (but if you still can’t feel we can adjust the base doseage).

What about a “walking epidural”?

I have heard a lot about this magical “walking epidural” but I have yet to hear of a doctor who’s ever done one or recommends them.

Epidurals do require extra monitoring of you and your baby, I can’t imagine having a patient walking the halls with them. Also, if you were able to walk, you would likely be also feeling all of your pain (which seems to negate the reason you have an epidural).

Can I have a C-section with an epidural?

If a woman already has an epidural in she can have extra medication through the tube to get numb for c-section.

However, for a normal C-section they use a spinal block — which basically changes which membranes the medication is injected under, the medication works faster and is a bit stronger. I have a post about the epidural vs the spinal on my sister site.

BTW, if you have a scheduled C-section I have a post that has all the things you’ll want in your c-section bag.

What about a CSE (combined spinal epidural)?

Some doctors give a patient a spinal and then place the tube in the epidural space. This is extra helpful when a woman is in a LOT of pain when she receives the epidural.

It is done at doctor’s discretion and preference. Some seem to like it, some don’t. Personally, you want your doctor to place it the way that he/she is most comfortable — so, I’d stick with that.

Get it, stick with that? See what I did there?

Is it possible to have a painless labor?

Yes, it is possible (although not for all women) — but it is not considered the safest or best route for childbirth.

You should have some pain to be able to:

1. Move
2. Know when it’s time to push
3. Have some “feedback” when you are pushing

Does it hurt to have an epidural?

I have a whole post to answer the question — does it hurt to get an epidural

But, in short — I think the placement of an epidural is very similar to the pain involved in your IV start.  That at least gives you a frame of reference (as you’ll have to have an IV before you have an epidural). The epidural takes about 30-45 minutes for placement — on average.

Once the epidural is placed, you don’t notice the placement area until a few days later when the shower hits it — it will likely feel like a bruise at that point.

Most people believe that the pain of childbirth is much more painful than the epidural placement.

Problems that can happen with an epidural

Note: Your anesthesiologist should do informed consent during an epidural placement — and should go into ALL of these areas. If they don’t, feel free to stop them and ask the risks and benefits of the procedure they are about to do. Getting an epidural is a personal decision and you should feel free to discuss it with an anesthesiologist before you get it.

Any time the skin is punctured there are inherent risks (these are VERY rare cases especially the last two — but doctors are required to talk about them before doing the procedure):

• Pain at the injection site
• Infection
• Death

As far as infection, that is why we only allow one other person in the room during placement and the doctor will wear sterile gloves and create a sterile field on your back.

That will require putting your hair in front of your body as well as prepping the site with soap (which can feel cold).

Common side effects can include your blood pressure dropping, itching and feeling sleepy.

There are a few other specific things that can go wrong with an epidural (and cause it not to work)

1. The catheter can “migrate” — or sometimes just pull out.  The doctor will tape your back a LOT, but as we move you, there’s always the chance it could pull out (or could move internally).
2. You might have a “window” where the spinal nerves are bundled and the spinal medication can’t get to.
3. Sometimes they don’t get it right on the first try and it’s just not effective — in which case, the only thing they can do is try again.
4. They can push the needle a bit too far and you can get a “spinal headache” (a pretty severe headache that happens more when you sit up). It happens because you lose a small amount of spinal fluid (which isn’t dangerous, just painful with the headache afterwards). They they can counteract with a blood patch (sounds worse than it is). This is the most common complication of an epidural

Keep in mind that the placement of an epidural has many factors including:

1.  How you’re positioned (that’s up to you to listen to the doctor and follow orders).
2.  Your anatomy (and yes, skinny girls are often easier to get it in than larger girls). But, it also has to do with where your fat is located and how your spine bends.
3.  Doctor skill.

A lot of the epidural is feeling your anatomy, so they can get in the right spot — so that takes cooperation between you and your doctor.

Keep in mind that labor has inherent risks as well and not having an epidural often puts a lot of stress on moms who aren’t prepared.

Alternatives to the Epidural

There are 4 basic pain mangement options (I go over all of them in my podcast on pain management options):

• Epidural anesthesia
• IV pain medication
• Nitrous Oxide (not available at many hospitals in the US)
• “Natural” (or medication-free) pain management techniques

Be sure to speak with your provider about them, so you can know the best pain relief option for you and your delivery.

What you can do to make an epidural block easier?

Things you can do to help your epidural:

1. Listen to your nurse/anesthesiologist to position yourself as well as possible (see this post about what labor nurses do).
2. Stay still — a moving “banana” (from my analogy above) would certainly be extra hard to get it right!
3. Be realistic — as I said above — your pain will be 80% taken away.
4. If you want an epidural, be sure to let your providers know, and feel free to put it in your birth plan (so the nurse can watch out for the best time for you to get it).
5. Give your nurse as much info as you can.  Did you ever get pain free, is it in a specific spot?  That helps us know if there’s anything we can do?

I’d also recommend having some basic pain management skills going into labor — whether you are planning on an epidural or not.  I share one of women’s favorite ways here.

And that, my friend, is the real magic (because you’ll need pain management techniques for the next 18-40 years with that child).

How long does the epidural last?

The short answer, as long as you want (as long as the tube stays in the right place) –but I have a whole post on how long epidurals last.

The hope is definitely that the epidural lasts so that you don’t feel the baby coming out.

When Should I Get the Epidural?

I have a whole post on my sister site The Pregnancy Nurse on when is too late to get the epidural.

Most people do best when they get it after the first stage of labor, but discuss with your providers when they think the right time is for you during the labor process.

Labor Pain Management Classes

Ok, we’ve talked a LOT about the epidural. Most people find it helpful to go through the entire process together with me explaining what each step is for and when you’ll likely need to do. That’s all covered in the pain mangement section in here.

The Online Prenatal Class for Couples, has a great pain management bonus video that will show you:

• Breathing techniques
• Positioning to help with the pain
• Household items you can use to help (like a heating pad)

Imagine me, right now, waving pom poms in your face saying GET A PRENATAL CLASS!!! Both of you taking one together is going to make you feel SO much more comfortable at delivery — but you don’t have to take my word for it #readingrainbow

In short, a bit — if an epidural is working correctly — it should take away 80% of the pain.

So, that’s the nitty gritty on what you should expect from your epidural.  Just a reminder this is part of a series all about labor epidurals.  don’t miss the others:

• Does it hurt to get an epidural?
• Epidural during Labor — the procedure & more.
• How long should my epidural last?

Have you had an epidural? Tell us in the comments what YOU felt!

The post Does an Epidural for Labor Completely Take Away The Pain? appeared first on Pulling Curls.

First off, who am I and why should you even consider my information on birth doulas?

Hi, I’m Hilary — many people know me as The Pregnancy Nurse . I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. ​ After being at the bedside for 20 years I saw a LOT of doulas, both good and bad. I have also navigated the treacherous waters of social media and doulas.

I have worked with AMAZING doulas that I wanted to hug for all the support they provided the patient, they also made my job easier.

I have also worked with doulas that were not helpful and even some that made my job exceedingly harder (and also harder on the patients). I want to share with you how to decide if you need a doula and how to pick one that will work for you.

Truth is, I think this is so important I brought one of my favorite doula friends about finding a good doula who has boundaries.

What is a Doula?

A birth doula is someone you hire to support you through labor — a labor coach.  Sometimes they teach prenatal classes or meet with you during your pregnancy to give you tips and tricks. There are actually many types of doulas. A doula is someone that can help you through lots of phases of life, there are even postpartum or death doulas..

Their services can vary pretty widely.  There is an organization for them called DONA International (there is more than that one, but it’s the one I’ve been most familiar with), where you can certify.  Many of them help you match internships with experienced doulas.

Doulas can be certified (most often with Dona International), but many aren’t. It isn’t regulated like an RN — which is a license vs a certificate. In fact, in my podcast I learned that some doulas would prefer not to certify (especially if they also work in a birth center).

It can be confusing to navigate the world of hiring a doula. The lack of regulation doesn’t help at all.

What do doulas do?

You can really boil it down to someone to support women in labor.  They’re very hands-on in helping you cope with the pain.

• Natural Pain management
• Helping you make healthcare choices (they should help you communicate with your team, not communicate for you)
• Encouragement & moral support to keep going!

Mostly they’re your educated cheerleader, as well as a translator that can help you know what is happening. They can be an extra pair of hands, an extra brain for ideas. The support of a doula can be REALLY helpful!

Another thing that doulas do is educate you. HOWEVER, you can totally do that on your own before baby. In fact, I 100% encourage you to.

It has NEVER been easier to get prepared on your own timeline with someone you can trust. In just three hours (or longer if you want to get more info The Online Prenatal Class for Couples can help you know what to expect! In fact, it guarantees you’ll feel more at ease about your upcoming birth.

And frankly, doula or no doula, make SURE you take a prenatal class in your third trimester (or before).

Pros and Cons of Doulas

Advantages of a doula

There are many benefits of having a doula — let’s talk about them!

Can be a support

If you are delivering alone, I would really recommend getting a doula.

There are women out there who don’t have a person to support them during the labor.  The reality is that I can’t be in your room all the time.  I have to pee, grab supplies, chart, and I may have another patient.  BUT, you could also grab a friend whom you love and trust.

I had a patient who hired a doula.  She didn’t want her mom in the room (the father wasn’t involved) and that doula was REALLY helpful.  The woman was a mess.  I had other patients, I couldn’t put this woman’s pieces back together.  Again, super helpful doula.  And this woman REALLY needed her as she had no other support system.

They have a basic knowledge of labor and delivery

With most things, this varies widely (and I mean WIDELY).

 If they are certified they should have some basic knowledge that is correct (although, there is no way to know how correct their knowledge is). Keep in mind that a LOT of your doula’s education will come from her own birth(s), her limited training, and any patients she has assisted.

It’s nice to have someone constantly at your side who has educated answers.  

She has hopefully seen many births and will be able to help you navigate your birth choices with a bit more ease.

Doulas can be especially helpful at home before you go to the hospital. They can answer questions and discuss what you’re feeling.

She is there just for you!

Your labor nurse won’t be in the room all the time and the doula can be. Their continuous support is easily one of the biggest perks to doula! This can both be physical (helping with pain management and labor support) and informational support in helping educate you on what to expect or to get your questions answered by the medical staff.

FYI, nurses can have up to 2 patients, we also often run into other rooms for emergencies, etc. You need to expect that your nurse won’t be in the room with you all the time.

Can be familiar with your provider

That means, they know how your doctor likes to do things and that could be helpful to educate you since sometimes the medical staff doesn’t have time (or aren’t great at communicating).

Your doula should be a support to the medical professionals around you, not making you question them. I find asking providers about doulas they prefer can help aid in this. Hospital staff may have doulas that they have found are better than others.

She can also provide support to you during things like IV’s or painful vaginal exams.

Doulas may decrease your chances of interventions.

There are a lot of studies that show doulas can help lower birth risks and interventions in expectant mothers. There is even an ACOG article that says (ACOG is the professional organization for US OB’s):

Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved birth outcomes for women in labor.

ACOG Approaches to Limit Intervention During Labor and Birth

That all being said, in my experience, I see a variety of reasons for the decreased interventions (they tend to have clients with good prenatal care, higher socio-economic statuses — etc).

Here are some good things doulas can do:

• Find a comfortable position (sometimes helping prop you up with physical support as well).
• Use position changes to help baby into the vaginal birth canal & prevent cesarean births — different positions can be a HUGE help to you and hospital staff.
• “Natural” pain management techniques (breathing, hypnosis).
• Massage or other pressure.
• Help your partner provide you relief.
• Provide stress relief during hard labor.
• Talk to you about your birthing process so you know what to expect next.
• They can also help you labor at home (using tools like heating pads) to decrease your hospitalization time.
• Explain what’s going on so that you’re not caught off guard (but I would 100% also recommend taking a prenatal class).
• Doulas may also help you adjust to your postpartum period or the new baby.

And, because they help you to relax that can help decrease your overall labor time.

** As I have said, a great doula is such a win. However, you have to remember that in the vast majority of cases people who use doulas are more well-off because they can afford a doula (they are not part of routine hospital births). Hence, I take the studies with a bit of grain of salt. Correlation does not mean causation.

Disadvantages of a doula

There are also many con’s to hiring a doula — let’s talk about those:

Doulas can get in your partner’s way.

I really believe that God created labor to bring those parents together in the pain/effort that culminates the start of their lifelong parenting journey.

If you want your husband playing candy crush in the chair while she does the hard work, by all means, hire a doula. {note: sarcasm font — not every delivery is like that — but I have certainly seen husbands hire doulas, so they could check out}. BTW, I have a post on my best tips for dads in labor.

I love seeing supportive husbands.  It shows me that that woman will have the support in her next journey, raising the child.  If you and your husband really want to prepare for this — I have the answer!

How much do they REALLY know?

Yes, they have a basic understanding of labor, but my job is to know ALL about labor.  It’s what I do, it’s my job.  I go to classes, I went to five years of nursing school, I discuss it with doctors when we’re at the nurse’s station, we read articles.

I am ACLS, BLS, NRP and AWHONN fetal monitoring certified and do a lot of continuing education.

Nurses are up to date on the most current info.  My job is to KNOW labor and especially the complications of labor.

You’re already paying your nurse.  Ask him/her questions, let them help you understand.

Ask your doctor questions — you’re paying for them to educate you as well!

Their Skill/Knowledge Varies Widely

Again, I don’t mind doulas (I really don’t, you might guess otherwise with this article) but sometimes you get ones who are so early in their practice that they aren’t helpful to the patient and they’re in your way or questioning you.

To me, It’s super annoying.  New doulas are not helpful.  In fact, I often find them a deterrent.  It takes more of my time to correct them or to talk through misinformation.

There are a few I’ve worked with who are WONDERFUL.  I’d say if you’re looking for one, I’d get a LOT of references and ask how much they felt the doula helped.  I’d ask the doula how many deliveries they’ve been to.

Experience is the most important thing in finding a good doula.

Doulas May Not Want to Support YOUR Birth

If you switch to an epidural or use pain medication mid-labor — will your doula be upset and be unable to support you? What about going to a c-section — will they support you in that choice as well?

Some doulas only want to support home birthers or people birthing the way they think is best. So, when you interview your doula, ask how they support in a variety of ways! This is REALLY important, because no amount of doula support can help someone have the perfect birth they are hoping for — mother nature has the ultimate call.

They Can Be Expensive

A good doula is expensive.  And, if they’re not expensive, they probably aren’t that good.  This is their job.  They make money doing it.

In reality, I think good doulas probably make more for a labor than I do.

It’s hard work.  A good doula earns her money.

I guess you just need to ask if you could use that money more efficiently in your child’s college fund.  I know for many parents the money isn’t the issue, so this won’t matter.  BUT, if money is tight, I think it’s time to step back and re-evaluate your finances.

Doulas CAN NOT GIVE MEDICAL ADVICE.

In no way, shape or form can a doula give medical advice. They are not trained, medically, and should only support you through communication and basic education to get the information you need to make choices. They also are not trained in any medical procedures (including vaginal exams).

Let me repeat: Doulas are not trained in medical care.

Many doulas say that they can prevent cesarean section, but in no way can your doula promise that. They can help, and there is a LOT you can do to try to avoid one — but it can not be guaranteed. No doula can promise better outcomes just for your birth.

Real quick– back to my first dis-advantage — let’s talk about your support person.

SO many moms get educated themselves, but when I created my class I knew that partners needed the support as well. The Online Prenatal Class for Couples is created to NOT overwhelm partners. It gives you the option to deep dive into things you’re hoping to get more info about and you can just watch the main videos with your partner. It really gives both people whatever experience they’re hoping for.

I love what M. Moyle said:

“I’m a family physician who previously worked in Labor and Delivery. I’m pregnant with my first and wanted to include my husband in understanding what to expect. Hilary’s course is concise, medically accurate, and practical. Highly recommend”

People love all the experience, how quick it is to get JUST the right info on your own schedule and I keep it simple and understandable.  I think you’ll love it — I even guarantee it.

What is the Difference Between a Doula and a Midwife?

There are different types of midwives.  In the hospital, only Certified Nurse Midwives (CNM) are allowed to practice.

In Arizona within a few years, that person has to have a doctorate of nursing along with a master’s in midwifery (plus, a bachelor’s in nursing, and most practiced as L&D nurses before they became midwives).  So, essentially — you could also call them doctor.

There are also lay midwives who go through other training.  I’m not familiar with them/that training, so I can’t comment on that.

BUT, Certified nurse-midwives are AWESOME.  They often do the work of a doula – in helping with positioning and pain management techinques. However, they may also have several patients — they may not be able to be in your room all the time either.

The midwife will also deliver your baby (as long as things go according to plan).

I want to be very clear that doulas should not, nor are they trained, to do any medical intervention at all. They are not considered health professionals.

Certified Nurse-Midwives can do many of the things that doctors can do, and are great for a low-intervention labor (read: not high risk).

Is a doula necessary?

Absolutely not.

You WILL have a labor nurse who should be willing to answer questions and help guide you along your L&D path.

However, she won’t be in there constantly, and hands-on natural pain management isn’t really her job as she is consumed by many other things (but is a willing teacher to your support team).

If you want 1 on 1 involvement, a doula might be your best choice.

Should I hire a doula?

I think if you feel like your husband might get overwhelmed, you’re wanting to go natural, or you lack trust in your MD (and are unable to change) it might be a good plan to hire doula services for additional support.

I 100% think you need to talk it through with your partner.  It is just as much their delivery as yours.  If the thought of having a stranger there bothers them, you need to take that into account.

People who should consider a doula:

• If you have your heart set on a “natural birth”.
• Hoping to not get an epidural or can’t for a medical reason.
• You aren’t a strong advocate for yourself, and neither is your partner (you could also consider a good family member).
• You are uncomfortable with your provider, and for some reason are unable to switch.
• You strongly desire 1 on 1 support through the entirety of your birth.

Tips if you are hiring a doula:

1. Get references.  I would ask for SEVERAL references.  Many doulas are recently out of training and don’t actually have much experience of their own. 
2. Only hire a doula who is prepared to be flexible and support you no matter the choices you make during your labor.
3. Talk to your provider. I would also ask your MD if they have recommendations (as having your doula and your MD at odds is a very awkward situation).
4. Decide what services you’ll need — many doulas provide care before delivery and after delivery — and clearly, all those services cost extra.  

Things to consider in your doula:

• Training
• Certification(s)
• Experience
• Hours of availability (and what do you do if she can’t come)
• What types of services they provide
• How comfortable you feel with her (if she’s a good fit with you!)
• The cost

Sidenote:  Many doulas offer placental encapsulation, but if they’re pushing it you might want to steer clear of them as it is strongly discouraged anymore.

Birth Doula FAQ’s

Is a Doula a waste of money?

They CAN be. I’ve also seen some 100% be SO helpful and really make the birth extra special.

But my own personal opinion, after almost 20 years as a labor and delivery nurse.  In a perfect world – the people who were there when the baby was conceived should be there when the baby comes out.  Plus a doctor and 2 nurses.  Possibly a mom, if that’s important to you.

I also really thought this Salon article of a women who didn’t appreciate her doula to be an eye-opener (because a lot of people end-up feeling this way but don’t talk about it — I find).

I think you should only become pregnant if you feel like the other person empowers and supports you.  Of course, this is in a perfect world.  And most babies aren’t born into a perfect world.

I really think you need to weigh the doula negatives with the positives and decide what works best for your family.

Do I really need a doula?

I thought this video was really great.  She seems like a wonderful doula.  She’s honest about what she can do and how she supports.  Hopefully, she gives you some ideas if you want to doula or not.

I hope, if you’re pregnant, you have a wonderful labor and delivery experience — grab my birth plan template (which is in my Free Beginning Prenatal Class below) to get centered on what you’d prefer on your delivery day:

Hilary is a labor and delivery nurse who has worked in various medical fields over the past 18 years.  Please don’t take any advice you read on this blog over something your doctor tells you.  Trust your doctor, or find a new one. 

This post was originally written in 2015, and has been updated since then.

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