An epidural is a great tool to use during labor if you need rest and/or relief from contractions.
But epidurals can make movement slightly more challenging during labor and while pushing.
We can still move, but we may need more support, and depending on the density of the epidural, we may be limited on movements.
The biggest complaint that I hear from my clients who have had epidurals in the past, was that when it was time to push:
- they couldn’t feel anything
- they didn’t know when a contraction was coming
- they didn’t know if they were even pushing correctly.
Here are our tips for pushing if you choose to get an epidural during birth so that you can still feel in control of your birth!
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1. Choose Your Position
You can still push in all sorts of positions even with an epidural! At a minimum, you can push on your side or with support under your back to still make space for the sacrum. If you can move, you can even try all fours or kneeling, using the back of the bed as support! If you choose to push in all fours or kneeling, it is important that you are able to get into that position without much help. If your support persons need to physically lift and move you, it is unsafe to be in that type of upright position.
Another upright position that is usually accessible for an epidural is the throne position! This one is usually easy to be supported by the bed!
If you choose to push on your back, we still want to make space for the sacrum. You can either roll up to towels, so they lay like railroad tracks for you to place each hip onto, or form a “u” shape with the towels. In both of these layouts, we want the sacrum to be floating in the center with the towels supporting your hips to allow for the sacrum to move freely.
Another option is to take a rolled-up blanket or pillow, and line it up vertically with your torso along one side against your back. This will tilt you slightly to the side so that there is still a gap for your sacrum to move.
Side-lying is another great pushing position to try if you have an epidural. It is easy to get into and doesn’t require much additional support or physical effort on others’ part. In side-lying, your partner can help control your top leg, and the bottom leg can lay on the bed without anyone else needing to support it.
In between pushes, you can place a peanut ball between the ankles; or place your lower leg into a stirrup for support. This position can help you keep your legs closer together to hopefully minimize tearing, and prompts internal rotation to open the pelvic outlet.
2. Add Some “Oomph” As Needed
Sometimes with an epidural, it can be harder to feel what is going on (which is understandable given how an epidural is supposed to work). Adding some extra oomph can help us redirect our pushes to be more effective. Pushing techniques like grabbing the bed handles or doing tug of war can be really helpful to add some extra effort to our pushes.
When grabbing the bed handles, we recommend grabbing underhand, so reaching under the handles to grab them with fingers facing up. This helps to engage the back more, which can direct the direction of the push downwards.
When we grab overhand, or fingertips facing down, we tend to flare the elbows out and use more of a lift in the shoulders to pull (not as helpful, and more of an upward direction of pull).
If you are confused, lift your shoulders up as if you were pulling something up. Do you feel where the direction of energy seems to go? More upwards? Now, focus on pulling your shoulders down and back, and feel your back engage. You can try to pull your elbows into your sides as if you were rowing. Do you feel where the direction of energy seems to go when you focus more on engaging your back? Do you feel it go more downwards?
Hopefully, that helps you better understand why it is helpful to think to pull with our back, as opposed to with our shoulders.
3. Turn Off the Epidural
Another option is if you just CANNOT feel anything: you have no idea when the contraction is even coming; you can’t feel the pressure of your baby or where to even direct your pushes… you can ask to turn off the epidural.
You will still have pain relief for a good while, and it can be restarted if it takes a while. But, allowing the epidural to wear off a little so that you can feel pressure (not pain) can be really helpful!
This would be a great option to discuss with your team beforehand to better understand what to expect if you feel that your epidural may be too strong for you to feel even pushing!
4. Counter Pressure: Open the Lower Midpelvis and Outlet
We can add some external counter pressure to help create more space in the pelvis! Two main options are to do a single knee press to open the lower midpelvis more. This can help your baby finish their rotation to get under the pubic bone. And the second option is to do cooks counter-pressure, which tends to open the outlet more.
Single Knee Press: Place your palm on one knee, then press directly back. Think driving the femur back into it’s socket. This can usually be done most easily in side-lying position. I tend to favor the left side when doing this, but you can experiment with both to see which one feels better for you!
Cooks Counter Pressure: Place your palms over both sitz bones, and then gently press forward as your partner pushes back into your hands. This can help to push the ischial tuberosities, or the sitz bones, further apart from one another!
5. Think Push a Tampon Out
You may be queued to push like you’re pooping. This can be helpful because it is the same area. But it is a subtle difference to push a baby out versus poop.
Rather, think push a tampon out. If you have never had the pleasure of doing that, insert a clean finger into your vagina (during pregnancy), and think push your finger out.
Now, note how that feels different than trying to poo. It’s very subtle, but it’s different. So, if you’re finding that you are not quite getting where to direct your pushes, or it is taking a long time… focus on trying to push a tampon on and see if that helps your pushes be a bit more effective!
6. Internal Feedback
If you are still not sure where to push, sometimes your nurse or provider adding some pressure just inside your vagina can be helpful.
If you feel the increase in pressure from their touch, you can try to direct your push there. Some can even assess how baby is moving with your pushes and give you more feedback on what “works” so that you can repeat that sensation!
They don’t need to keep their fingers in you the entire time, sometimes just one push is enough to feel confident to keep going with what you learned from their feedback!
7. Labor Down
If you are 10cm, but you don’t feel lots of pressure yet or an urge to push (you can still feel the urge even with an epidural sometimes!), it may be helpful to labor down.
This is when you allow your body to passively push baby down for you so that when you actively push, there is a lot less effort on your part!
Pushing with an Epidural: You CAN be in Control!
You can still be in control when pushing with an epidural! You have so many options with positions, feedback methods, and tips to push.
If you need more support, ask for it! Your team is there to help you meet your baby. If you feel confident to do it with less help, let your team know! You got this!
Learn more about pushing in our upcoming pushing webinar. We break down pushing in all our online childbirth education courses so that you can feel more confident when pushing to meet your baby!