In my childbirth classes, I spend a lot of time talking about pushing with an epidural. Many of my students get epidurals (according to some statistics the national rate is about 71%) and one of the side-effects can be a longer or more difficult pushing phase, though this depends on a number of factors.
You can’t feel the contractions with an epidural, but the potential downside to anesthesia is that there’s increased use of forceps, vacuum extraction and episiotomy. The precise increase of these other procedures is hard to determine from the research we do have–here’s a very thorough look at the data on this topic– but it’s significant enough that I like to address ways to go gentle on the pelvic floor during a medicated pushing phase.
So I was thrilled to discover EvidenceBasedBirth’s blog entry on this topic and an accompanying video. Watch it to see exactly how you can make the most of pushing with an epidural:
I also recommend having the epidural as late into the labor as possible– try other coping strategies first, so you have more mobility for a longer period of time– turning the medication down before pushing, or asking for a “walking epidural” (you won’t be “walking” but you may be able to bear weight on your legs or knees, which can help).
“Summary of the Evidence:
- For women without an epidural, pushing in an upright position is associated with a decrease in the risk of episiotomies, vacuum and forceps-assisted deliveries, and fetal heart rate abnormalities, an increase in the risk of second-degree tears, and a possible increase in the risk of having blood loss more than 500 mL
- Women with walking epidurals who push in upright positions may experience a shortened labor and pushing phase
- More evidence is needed to evaluate pushing positions in women with traditional (non-walking) epidurals
- The take home message is that women should push in any position they find comfortable— it is not necessary to be continuously upright or continuously lying down during the pushing phase.“
— From Evidence Based Birth.
Has anyone reading this had an epidural and pushed in an upright position or changed position?
I’d be curious to hear how it worked out.
From my experience, mom has to be very pro-active to get off her back or have a care-provider who highly supportive of mothers at least trying a variety of positions for pushing.
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