Epidural is the most common form of anesthesia used in childbirth. An epidural numbs the entire area between your breasts and knees. You can only have an epidural if you are in a hospital. This is not offered at a birth center or home. It is administered by an anesthesiologist, a needle in the back that is full of the medication used to numb you.
The Urge
As baby descends and rotates through the pelvis to travel to the opening, birth givers may feel an intense urge to push. It’s best to push at the peak of a contraction to help your baby wiggle themselves down and out through the canal.
Unfortunately, oftentimes an epidural can take away the sensation to push which can become problematic as it lengthens your birthing time leading to unnecessary interventions.
When To Push
ACOG (American College of Obstetrics & Gynecology) Recommends laboring down by the waiting until baby’s head is engaged with a fully dilated cervix.
How To Push
Under anesthesia, the birth giver is limited on the number of possible positions, which can slow or stall natural progression of labor. Good doula support and other birth helpers can help you get into these positions which will likely be difficult to do on your own under anesthesia. Push with your booty not your stomach. Breathe the baby down and use your breath to help guide baby thru by working with that contraction, other words ride the wave.
Epidural Complications
Epidural will reduce the amount of sensations and discomfort you may be feeling and more sensitive to during your laboring and pushing. However, the risks are:
Increased length of the time for the second phase of birth, because your muscles are less able to help rotate your baby into preferred positions for giving birth
Them offering an episiotomy (cutting your va-jay-jay, to “help”, no thanks!)
Forceps or vacuum to extract the baby out, this can happen even without epidural, it is your choice. Forceful nature of pulling baby out can cause birth trauma to baby and birth giver. Consider bodywork for you and baby if you have to experience this.
It will likely take a little longer to push since you loose that sensation mostly if not all, depending on when you get it. I felt some sensation during pushing because it seemed to only take to one side and I got it later in birth, like shortly before the pushing.
They may try to offer you the synthetic form of the hormone oxytocin, Pitocin. It’s not bad, some people need it and others don’t depending on if it’s an induction or not. You can turn it on or off, up or down, you can control it. Sometimes they offer it after birth to help contract the uterus to push out the placenta.
Pushing
Video coming soon! You can push on your back, but it’s not as helpful to get baby to come down. So, try some of these positions in labor with your doula or birth partner. Ask a nurse to help if you are alone. You can be on your side, knees, sitting/squatting.
Keep moving during labor whether your have an epidural or not to make sure it does not stall, leading to increased risk of cesarean by the hospital intervening on your trial of labor time.
Instead, change positions often, aim for every 3-5 contractions which can be a long or short time depending on how far you are in your labor with progress.
Definitely try to keep it at bay as long as possible to avoid negative side effects to you or baby. It can interfere with milk production by causing a delay in the onset of your milk supply establishing.
If you have an epidural, especially for a long time, you may want to seek an IBCLC while in hospital to make sure there are no issues and also a follow up out of hospital.
Final Note
If you think you might want an epidural, please talk to your OBGYN and Birth Supporter about ways to handle the pushing phase of labor with an epidural. Knowing all of your options helps you make informed decisions during labor and birth. I had two epidurals and while I didn’t have any major complications with it, I wouldn’t get another due to the way it made me feel after and the repercussions of sciatica 13+ years later. Yikes!
As a doula, I’ve been at labors with and without epidurals. The best piece of advice about them in my opinion is to wait for as long as you can go without getting one to delay or prevent any negative side effects or unnecessary measures. You want a number don’t you? Many midwives I work with say wait until after 4cm dilated to avoid too much interference. I was about 8-9 when I got mine each time. Do what feels right for you and your baby, you know your body best and what it needs. Ask for what you need and always have knowledge of the benefits, risks, alternatives, intuition and even ask what happens if we do nothing. In my opinion, this is your best way to handle epidural pain management options if giving birth in a medical setting.
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