How an Epidural Effects Pushing:
- Increased need for pitocin
- Increased need for forceps or vacuum extraction
- Increased use of episiotomy
- Increased length of time for pushing
Epidurals can also increase the length of the second stage by numbing the muscles in the vagina. Since the muscles are a bit more lax, they cannot provide the baby with the same type of taut muscle to help rotate into preferred positions. Epidurals can also interfere with the oxytocin feedback mechanism, meaning that additional oxytocin (pitocin) is needed to enhance labor. This does not have to mean an automatic cesarean section but simply an altered thought process about the pushing phase of labor, also known as the second stage.
Urges to Push with an Epidural:
Laboring down also helps prevent the mother from feeling incredibly exhausted from pushing efforts. Remember that the uterus continues it's expulsive efforts even without the mother's assistance. But the benefit of allowing the baby to rotate and descend can be beneficial to everyone involved.
Positions for Pushing with the Epidural:
- Semi-sitting with people or leg supports
- Side lying
- Supported squat
- Kneeling on the foot of the bed, leaning over
- Supine with stirrups or leg supports
One thing to keep in mind when helping someone with an epidural is to be careful never to over extend their legs or other joints. It is possible to cause harm to the mother's body because she is not able to feel pain to get you to stop as she might normally if you were to overextend her joints.
Time Limits on Pushing with Epidural:
Lieberman, E., & O'donoghue, C. (2002). Unintended effects of epidural analgesia during labor: A systematic review. American Journal of Obstetrics and Gynecology, 186(5 Suppl Nature), S31-68.