Say what!?
It's true. I think epidurals can be a great tool. Don't get me wrong, I definitely advocate that birth is a normal, natural process and can absolutely be done without without pain medication. However, I definitely think epidurals have their place. So how does my role as a doula change when my client chooses to have an epidural? And what does my work look like for a client who has chosen to have an epidural from the beginning?
If I'm at a birth and a client is truly suffering ("suffering" and "in pain" are two very different things), and makes the decision to get an epidural, it becomes my role to keep them focused and in the laboring headspace as much as possible. While it's true I most likely won't need to be doing hip squeezes, counter pressure, or helping a client breathe and maintain rhythm through their contractions anymore, it can be hard to stay in the "zone" when there isn't a constant reminder of what exactly it is you're doing.
It becomes my role to maintain a calm and relaxing atmosphere, and help you remember that eventually, you will still need to push the baby out at the end. I will also (with assistance and permission from the nurses) help you with position changes to help keep labor from slowing down, and help you find pushing positions that still allow gravity to assist you without the use of your legs.
Now, why would someone need a doula if they know they want an epidural right away? Well, first of all, "right away" can mean different things at different hospitals. In some locations, you can't even be admitted to the hospital until you're at least three centimeters dilated. This means you will be contracting at home for a good while, and some of those early contractions can still be intense! All of the tools for early labor that sound simple but are actually pretty difficult (keep yourself distracted for as long as you can, rest when you can, etc.) still apply. This can be really hard to do, but having a doula makes it a little easier.
You also may not be able to get an epidural as quickly as you would like even once you are admitted to the hospital. Some hospitals have policies stating labor ahs to have progressed to a certain dilation number before an epidural can be administered, some hospitals don't have anesthesiologists on-staff 24/7, the anesthesiologist might be busy, etc. That means that even in active labor, you might have to labor without the use of pain medication for a while. My role as a doula is to help prevent suffering until you can get the epidural you're hoping for. Then, my role continues as it would for someone who wasn't planning for an epidural (keeping you in the right headspace, keeping the atmosphere right, position changes, etc.).
All in all, I think epidurals are a great tool when people need them, and I believe my support remains necessary when clients choose an epidural, whether that was the plan all along or something that became necessary along the way. at the end of the day, this is your birth story. I'm just here to support you through it.