Pushing with an Epidural
When pushing with an epidural, there are variations in how much sensation you may feel and how much movement capability you have, depending on the strength of your epidural.
If you have the ability to move, move! You can flip onto all fours or even move into a supported squat position!
If you need tons of physical assistance to move into a position, then it may not be safe for you, and we may want to focus more on positions that are supported by the bed, such as supine or side-lying.
Learn more pushing techniques, such as breathing techniques and how to approach pushing both unmedicated and with an epidural, in our pushing webinar!
We break down how to approach pushing in all our childbirth education courses and in a mini-course if you want to focus only on pushing!
Use the Bed!
When pushing with an epidural, we usually need to be in the bed. Good news is that the labor bed can be adjusted into so many different positions to support your pushing position.
If you feel unsure how to adjust the bed, ask your nurse to show you how or ask for their recommendations!
1. Supine: Create Space for the Sacrum
The most common pushing position with an epidural is to push on your back or supine/lithotomy.
But, we need to ensure that we still create space for the sacrum to move freely, or else we may find pushing takes a lot longer.
Fortunately, if you find pushing on your back is most comfortable, we can use props to create some space!
We can add a pillow along the torso to tilt us slightly or use two pillows to make a railroad track for us to be propped up. The labor bed also has a cutout portion that may help create space!
2. Sidelying
The next most supportive, and usually accessible position with an epidural, is sidelying!
In sidelying you are rolling to one side to push. This position seems to have the lowest risk of tearing, mostly due to your legs tend to be closer together and more relaxed! It’s also nice because you only need one person to help support your leg, which makes it easier to maintain internal rotation while pushing!
3. Throne
Supine and side-lying are more reclined positions, so let’s explore a few upright positions that you can achieve with an epidural!
The first is throne! We need to adjust the bed into a chair-like position, and then I like to set up the squat bar attachment so you can hold onto something.
With all upright positions, it is important that you can move into the position with fairly little assistance, otherwise, it may not be a safe position for you.
Throne is usually easy to get into, but may not be a great position to deliver in. But can be a helpful position to do during the earlier part of pushing to help move baby down!
4. All Fours/Kneeling on Bed
Another upright position is all fours or kneeling on the bed! You can use a stability ball or peanut ball to support your chest, or incline the head of the bed to lean on as you push.
Again, for upright positions, you need to be able to get into the position with little assistance, otherwise, it may not be a safe position for you.
5. Squat with Support
Setting the bed up in a similar setup as the throne, we can also do a squat position!
When doing squats, ideally, we do one that is more hinge-like (butt to wall behind us) than squat-like (butt to floor), but with an epidural and being restricted to the bed, the squat may look more like a squat as opposed to a hinge.
When doing a squat, we still want to focus on trying to find more internal rotation, so think knees in, ankles out.
I would not recommend delivering in this deep squat position, as it can increase the risk of tearing, but can be a helpful position to move baby down.
6. Add a Tug of War!
And finally, we can add some power to our pushes with a tug of war!
With the tug of war, you are pulling on a long fabric between the legs or above to help engage the lats to add power to your push.
Watch the reel for some examples!
You are not limited to only pushing on your back!
Even with an epidural, we can still make decisions about our birth! You can push in several positions and use props to support your pushing. Try to maneuver the bed in different configurations and shift around to find the most comfortable position!