How to Push Your Baby Out with an Epidural

The Pros and Cons of Getting an Epidural

Caucasian man helping girlfriend deliver baby
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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. Some studies show that there is an interference, while others show that there is no differences in outcomes.

What really matters is what happens with you and your labor. Knowing what to expect can really help you understand what's going on.

Urges to Push with an Epidural

The urge to push is what laboring women experience near the time of birth. 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. In 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. Laboring down is 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:

  • the mother from feeling incredibly exhausted from pushing efforts

Remember that the uterus continues it's expulsive efforts even without the mother's assistance. But the benefit of allowing the baby to rotate and descend can be beneficial to everyone involved. This was found in some studies, while others found no benefits, and near negligible risk of trying this method of pushing.

Many hospitals use this as their protocol.

Positions for Pushing with the Epidural

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

Please note that this varies from mother to mother, some women will have more movement than others, this might alter what you can do slightly though 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 some positions that the mother can still assume including:

  • 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

One thing to keep in mind when helping someone with an epidural is to be careful never to over-extend their legs or other joints. It is possible to cause harm to the mother's body because she is not able to feel pain. She doesn't know when to tell you to stop as she might normally would if you were to overextend her joints.

Time Limits on Pushing with Epidural

The research shows us that time limits, when both mom and baby are doing well, are 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. Sometimes simple changes in positions will be helpful at moving labor forward and bringing baby down.

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), which may "may not be as safe as once thought", according to a 2013 report from The American College of Obstetricians and Gynecologists
  • need for 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.

Sources:

The American College of Obstetricians and Gynecologists: Study Finds Adverse Effects of Pitocin in Newborns (2013)

Lemos A, Amorim MMR, Dornelas de Andrade A, de Souza AI, Cabral Filho J, Correia JB. Pushing/bearing down methods for the second stage of labour. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD009124. DOI: 10.1002/14651858.CD009124.pub3

Lieberman, E., & O'donoghue, C. (2002).

Osborne K, Hanson L. Labor down or bear down: a strategy to translate second-stage labor evidence to perinatal practice. J Perinat Neonatal Nurs. 2014 Apr-Jun;28(2):117-26. doi: 10.1097/JPN.0000000000000023.

Unintended Effects of Epidural Analgesia During Labor: A Systematic Review. American Journal of Obstetrics and Gynecology

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