How an Epidural Effects Pushing:
While an epidural is one of the best forms of pain relief for labor, it does also have its risks.
- 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.
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.
Positions for Pushing with the Epidural:
Since the mother is anesthetized she cannot assume many positions. This limit on the positions can hinder progress in labor. 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
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.
