Turning Off the Epidural for Pushing

Does it help reduce the risk of forceps and vacuum extraction?

Woman getting an epidural in labor
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Epidural anesthesia is a powerful form of pain relief commonly used in labor and delivery. It is strong enough to be used even for cesarean births, allowing a mother to be awake and alert for her baby's birth without experiencing the pain of surgery. However, as with anything, the epidural does carry risks. One of the risks frequently associated with epidural anesthesia is an inability to push effectively and/or an increase in the use of forceps or vacuum extraction, called an instrumental vaginal delivery (IVD).

A theory began to emerge that if an epidural was turned down or discontinued to allow a mother to have better sensation during the pushing stage of labor, that these risks would decrease. Many women were requesting this in an attempt to have better control. However, it was discovered that this theory does not appear to work in this manner.

One problem is that of pain relief. Once the body has been numbed with the epidural, it stops producing as many of the helpful hormones that allow natural pain relief, because the mother isn't experiencing pain. So to turn off the epidural at this point requires the body to catch up, in effect, to help alleviate pain naturally. This causes the mother even more pain at that moment than if she had chosen not to have an epidural and her hormones gradually increased with her pain.

"I've had natural childbirth - but turning it off was way worse," remembers one mother who opted for an epidural after a long labor, but felt like turning the epidural off would be a good idea.

"Thankfully we left the catheter in there so they could add medication to it and take the edge off. I won't make that mistake. My new motto is to commit to one method or the other and they each have advantages and disadvantages."

The other issue is that we don't really seem to be able to prove that there is a decrease in the instrumental vaginal deliveries.

There is a call out for more research to find a way to lower the risks of forceps and vacuum extraction births. One other way that is currently being used more effectively, without discontinuing the epidural, is laboring down. This is basically just allowing women who choose epidurals to labor a bit longer before beginning to push, allowing the fetal head to come down naturally. Many institutions are having a lot of luck with this technique, be sure to ask about it at your prenatal care appointments and in your childbirth class.

A good discussion with your medical team will help you figure out the best direction for your labor and birth. Many women find that the use of various positions in labor will be helpful at moving the baby down without the use of interventions like a vacuum or forceps. Some hospitals are also seeing successes with the peanut ball.

Sources:

Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia. Torvaldsen S, Roberts CL, Bell JC, Raynes-Greenow CH. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004457. Review.

A retrospective case-controlled study of the association between request to discontinue second stage labor epidural analgesia and risk of instrumental vaginal delivery. Toledo P, McCarthy RJ, Ebarvia MJ, Wong CA. Int J Obstet Anesth. 2008 Jul 8.

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