According to a recent study from the Center of Disease Control, approximately 64% of women whose births were attended by a medical doctor or a doctor of osteopathic medicine received epidural/spinal anesthesia (1). Given that the majority of women birth with the help of an epidural, it is important to offer useful information to facilitate a successful birth.
Once the epidural has been placed and the medication is administered, the mother can rest comfortably. She should continue to shift from side to side to help the baby maneuver itself through the pelvis and not get stuck in one position. This period of labor is rather easy with the epidural.
Some women find the second stage of labor, the pushing stage, more challenging. They have a hard time coordinating the muscles needed to push because they are numb from the waist down. Here are a few ways to help the mother find the most effective and beneficial ways of pushing with an epidural:
Laboring down means not pushing until the baby is well descended into the pelvis. Since the mother is already comfortably on pain medication, there is no reason to push just because she has reached full dilation if the baby is still high up. The uterus will continue to contract and push the baby further down the birth canal. Why exert so much energy to push the baby down when her body will naturally do it on its own?
Allowing for the baby to labor down takes some pressure off how long the mother can be in the second stage. Most hospitals have a time limit of how long the mother is allowed to push – usually two or three hours- before a cesarean is called for. If the first hour is spent bringing the baby down, the mother has wasted precious time.
Research has shown that delaying pushing for up to 90 minutes after complete cervical dilation resulted in a significant decrease in the time mothers spent pushing without a significant increase in total time in second stage of labor. In clinical practice, healthcare providers sometimes resist delaying the onset of pushing after the second stage of labor has begun because of a belief it will increase labor time. This study’s finding of a 51% reduction in pushing time when mothers delay pushing for up to 90 minutes – with no significant increase in overall time for second stage of labor – disputes that concern (2).
Wait for the Urge to Push!
This is a similar philosophy to laboring down. The numbing effect of the epidural will likely lessen the mother’s awareness of the urge to push, however, the mother will feel pressure on her pelvic floor as the baby naturally descends. It is suggested to wait until the baby is at least at +2 station before she begins to push.
Some care providers want the mother to be able to have some feeling in her body. This will allow her to feel the natural urge to push and have more control of her body when she is pushing. To do this, the anesthesiologist turns down the epidural, decreasing the amount of medicine flowing into the mother’s body.
Pushing Positions with an Epidural
Ideally the mother should not push flat on her back since it lessens the space in the birth canal. If the epidural has not been turned down, the mother will be more limited in her options since she cannot bear her own body weight. She can try side lying, semi-reclined or the “tug of war” position.
In side lying, the mother is on her side and holds her top leg while she curls around her belly. This position gives more space in the birth canal since it allows freedom for the sacrum and rectum.
In semi-seated, the mother is more upright as she is supported by a propped up bed or pile of pillows. She will still curl around her belly as she pushes her baby out.
The “tug of war” position is when the mother is in the semi-seated position holding on to a towel or sheet and someone else is hold the other end. If there is a squatting bar available, she can wrap the material around it as well. When the mother is having a contraction, she bares down while pulling on the material. The pulling action gets the back and abdominal muscles involved and can help facilitate more effective pushing.
I would also recommend that in both the “tug of war” and the semi-seated pose to slightly point the tailbone up towards the ceiling. This maneuver pushes the top of the sacrum down towards the bed and out of the birth canal.
If the mother has resumed some sensation in her lower body, she can try getting on all fours or squatting. Both of these options promote maximum opening for the pelvic outlet. Some women feel the all fours position promotes good bearing down efforts.
If the mother is on her back and the nurse or partner is involved, be mindful of how far back they pull the mother’s leg. Her sensation and awareness is compromised and she can over extend the leg resulting in straining the muscles, ligaments, pelvic joints or pubic symphysis (separation of the pubic bones).
Hope this offers a little more insight of your options for second stage with an epidural. Happy birthing!
*Disclaimer- not meant to take the place of medical advice.
Debra Flashenberg, CD(DONA), LCCE, E-RYT 500 is the director of the Prenatal Yoga Center. She has spent most of her life performing and was introduced to yoga through a choreographer in 1997. After several years as a yoga student, she decided to continue her education and became certified as a Bikram Yoga instructor. After being witness to several “typical” hospital births, Debra felt it was important to move beyond the yoga room and be present in the birthing room. In 2006, Debra received her certification as a Lamaze® Certified Childbirth Educator. In September of 2007, Debra completed a Midwife Assistant Program with Ina May Gaskin, Pamela Hunt and many of the other Farm Midwives at The Farm Midwifery Center in Tennessee. Drawing on her experience as a prenatal yoga teacher, labor support doula and childbirth educator, Debra looks to establish safe and effective classes for pregnancy and beyond. She is the proud (and tired) mother of new baby boy, Shay.
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