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How to Push Your Baby Out with an Epidural

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Area of Numbness with an Epidural

Area of Numbness with an Epidural

Photo © ADAM

How an Epidural Effects Pushing:

An epidural is one of the best forms of pain relief for labor, it does also have its trade offs associated with its use. This can include:

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:

In some women, the urge to push can be dampened or completely missing in the second stage. Laboring down is a term used to describe waiting to push until the baby is fairly far down into the pelvis. This allows the mother to rest, can prevent fetal distress, prevent prolonged pushing, perhaps prevent some fetal malpositions or allow the baby time to rotate into a better position.

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:

Since the mother is anesthetized she cannot assume many positions, because of the lack of feeling. This limit on the positions can hinder progress in labor. Please note that this varies from mother to mother, some women will have more movement than others, this might alter what you can do slightly, though it will still usually require a lot of support from those around you. With good support from the partner, doula, labor nurses and others there are some positions that the mother can assume.

  • Semi-sitting with people or leg supports
  • Side lying
  • Supported squat
  • Semi-prone
  • 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:

The research shows us that time limits, when both mom and baby are doing well, is not necessary. Since an epidural may increase the time needed to push the baby out, if mom and baby are doing well, ask your doctor or midwife if there is any reason why you shouldn't be allowed to keep pushing before a cesarean section is performed. Sometimes simple changes in positions will be helpful at moving labor forward and bringing baby down.
Source

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.

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