How to Push Your Baby out With an Epidural

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Epidural anesthesia is the most common form of anesthesia used in childbirth. Since an epidural numbs the entire area between your breasts and knees, you might wonder how you can push your baby out during labor. While some studies have looked at whether or not having an epidural alters how you push your baby out, the results have been mixed.

A 2017 review of those studies found that for women on epidurals, delaying pushing during the second stage of labor increased the stage by 56 minutes, but overall it was unclear whether the timing of when to start pushing had any lasting impact on moms or babies.

However, since then, the American College of Obstetricians and Gynecologists changed its stance on delayed pushing in favor of pushing based on cervical dilation.

The Urge to Push With an Epidural

Near the time of birth, laboring women experience the urge to push. Sometimes this urge is overwhelming and women describe it as something that their body is doing and they have no control over it. Other times, it simply means that it feels better to push, particularly at the peak of a contraction, than it feels to not push.

For some women, an epidural can dampen or eliminate the urge to push in the second stage of labor. This lead to the theory of laboring down, a term that describes waiting to push until the baby is fairly far down into the pelvis.

This allows the mother to rest and was thought to prevent:

  • fetal distress
  • prolonged pushing
  • some fetal malpositions or allow the baby time to rotate into a better position
  • the mother from feeling incredibly exhausted from pushing efforts

As of 2019, the American College of Obstetricians and Gynecologists no longer supports the practice of laboring down and suggests a woman starts pushing when her cervix is fully dilated.

Pushing Positions With an Epidural

Since an epidural anesthetizes the mother, she may not be able to assume as many positions because of the lack of feeling. This puts a limit on the number of possible positions, which can hinder progress during labor.

This varies from mother to mother. Some women will have more movement than others, and while this might alter what positions you can use, it will still usually require a lot of support from those around you.

With good support from your partner, a doula, labor nurses and others, there are several effective positions the mother can use for pushing including:

  • semi-sitting with leg supports
  • side-lying
  • supported squat
  • semi-prone
  • kneeling at the foot of the bed, leaning over
  • supine with stirrups or leg supports

One thing to keep in mind when helping a woman with an epidural is to be careful never to over-extend her legs or other joints. It is possible to cause harm to the mother's body because she is not able to feel pain, and may not know when to tell you to stop if her joints are overextended.

Epidural Complications

While the reduction of pain is a benefit of an epidural, this medication also increases the risk that you will:

  • need Pitocin, the synthetic form of the hormone oxytocin. (A 2013 report from The American College of Obstetricians and Gynecologists found Pitocin may not be as safe as once thought.)
  • need forceps or vacuum extraction
  • have an episiotomy
  • need more time for pushing than you would otherwise
  • increase the length of the second stage because your muscles are less able to help rotate your baby into preferred positions for childbirth 

The use of an epidural will most likely not have any great effect on your ability to push, with the most likely complication being a lengthier pushing phase. That said, many women gladly trade a few extra minutes of labor with the pain relief provided by the epidural for the alternative. If you are planning to have an epidural, talk to your doctor and doula about how you want to handle the pushing phase of labor.

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Article Sources

  1. American College of Obstetricians and Gynecologists. Medications for Pain Relief During Labor and Delivery.

  2. Lemos A, Amorim MM, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down methods for the second stage of labourCochrane Database Syst Rev. 2017;3(3):CD009124. Published 2017 Mar 26. doi:10.1002/14651858.CD009124.pub3

  3. ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol. 2019;133(2):e164-e173. doi:10.1097/AOG.0000000000003074

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