Pushing with an epidural

[omshantihi]

Hi, I was hoping for a completely intervention free birth but because of a higher risk of bleeding, my ob is insisting that I be on an epidural in case they need to go quickly to a c-section. I've agreed to have an epidural put in at 7 cm dilation (the other option on the table is a scheduled c-section). Anyway, so these were my questions. Are there more effective ways to push with an epidural in place? Alternatives to directed "purple pushing"? Would I still be able to get into suitable positions with assistance? Anything a doula could do to help? I'm looking for ways to minimize tearing/need for an episiotomy. Any suggestions would be welcome! Thanks!

[Magali]

Hi. I had an epidural with my son. I don't think I could have done any other position other than flat on my back because I couldn't use my legs at all. But, I pushed for only 20 mins and he was born. Mind you at that time in my life I didn't question the lying on back to push so maybe some other mama's can chime in better on that. My Dr. didn't direct me at all. We chatted in between pushes and I'd tell her when I felt pressure and I'd push. It was actually really peaceful. The pressure I felt was light, but it was there.

[rhiOrion]

Epidurals aren't an all-or-nothing thing. If you don't want the epidural, but you agree to having it, then ask them to keep it turned as low as possible.

I can only tell you my experience. I had to be induced for valid medical reasons and pitocin contractions were just too much for me, so I finally asked for an epidural. I was concerned about the same things that concern you.

My biggest fear was not being able to feel the urge to push. Therefore I avoided having them turn the epidural up when offered (I did use the magical boost button a few times, though!), I figured it wasn't hurting anywhere near as much as what I expected when I was planning a drug-free birth, so I could live with it kept low.

For the first push or two I really didn't feel the urge, but I think that was more timing than the epidural. As in, I think if I'd waited a few more minutes I would've felt the initial urge on my own. But once I was pushing I felt the urge to push with each contraction. I was encouraged/directed in the pushing, but only during contractions. Once I figured it out I told them when I needed to push, not the other way around.

I wasn't allowed to be in many different positions, though I didn't argue the point. I could feel my legs, but I have no idea if I could have supported any weight. But I could push against things with them, so I actually think maybe I could have. But anyhow, I didn't try.

We alternated between me being on my back and on my side. That was working okay, but what really worked well was playing tug of war with the squat bar.

They hooked the squat bar up to the bed, and then the looped a sheet around it. I was on my back and grabbed the sheet and pulled on it while I pushed. I either had my legs against the squat bar or I had people holding my legs for me.

Towards the end of the pushing I think I could have pretty much stopped. She started coming out on her own. I could feel her head easing out without my help.

I did end up tearing. I wish I'd stopped pushing at that point at the end. Or at least eased up a little. But I think they were concerned about her heart rate at that point and just wanted me to get her out, so they kept encouraging me to really push.

So, basically, my suggestion is that if you're going to be stuck on your back/side to talk over all the different options. The tug of war with the squat bar really helped me a lot. You should be able to be on your side, if you prefer that (I actually preferred to be on my back for whatever reason...and I HATED when I had to change. Turning over with a head in your crotch is difficult).

Another thing I recommend is to discuss what you'll be allowed to eat/drink. Since it sounds like a c/s is a bigger risk for you I'm sure they won't want you to eat. But see if you can bring something to drink that is more nutritious than what they probably offer (they kept trying to get me to eat one of their sugar-packed italian ice things rather than my more nutritious odwalla juice). Because it's hard to push if you haven't had any nutrients in hours and hours (in my case 27 hours).

[mizznicole]

I hope some others chime in because I don't see why the epi is necessary. I'm speaking as someone who had an unplanned c-sec. Once we decided it was needed, the did a spinal. Interested in other responses.

[cileag]

I wonder too about the "required epidural". I'm an L an D nurse and I haven't heard about any bleeding issues that would require an epidural. Anti hemorraghics need IV access, but that's a pretty big intervention and I'd urge you to double check whether or not it's truly necessary.

That being said, with epidurals, I always recommend laboring down for as long as possible---truly, as long baby is tolerating labor fine, if you can't feel pressure, don't start pushing. I would hope that they would be flexible about this, but it doesn't sound like a particulary mama-friendly hospital.

[luckiest]

I also have a question about the bleeding risk requiring an epidural -- what kind of bleeding risk are we talking about? (Of course feel free not to answer, I understand this is personal medical information). The first thing that came to mind was some kind of clotting disorder that would make it tough to stop bleeding, but in that case wouldn't surgery be the biggest thing you'd want to avoid? Unless the bleeding risk is that for some reason they think you may have placenta problems, like an abruption during labor, the epidural doesn't make sense to me.

In any case, you could always request that the epidural be kept very low so you still have some sensation and can potentially use different positions to labor and push. "Laboring down" would help as well, like the above poster mentioned.

Best of luck!

[westcoastlady]

With DS I had an epidural after 48 hours of labour as my contractions were slowing down due to exhaustion. I napped for a few hours and then waited for a few more hours until it was time to push. Somewhere in that part my epi stopped working... as least for the contractions. When it was time to push I had trouble at first feeling the urge but that may have had something to do with DS being sunny side up. I was able to push in all positions - hands and knees, on birthing stool, squatting, on my back with squatting bar - I did need some help changing positions but it was mostly due to all the cords and everything. I would love to be able to have an intervention free birth next time but I know for me, that two hour nap saved me from a c-section as there is no way I could have pushed for six hours with out it.

[KoalaMommy]

Sounds to me like your doc is planning for a c-section.

I've had epidurals for all 3 of my children, and I was completely numb when all were born. Not that I advocate for this, I really believe in natural childbirth, I just seem to have 2+ day labors without rest so it is what it is.

Anyway, you do not have any pushing position options because you can't feel your legs therefore can't stand up. And I know all the literature says you're pushing up hill and it's hard to push the baby out, yada yada yada, but honestly, my first I pushed for 1 hour, which is average, my 2nd I pushed 3 times and my 3rd I pushed twice. So personally, I couldn't say that it was a particular challenge. If you have good assisting staff, they will have you push to take advantage of your contractions so you're not actually purple pushing, you just don't feel the need to push because of the epi. But I did always feel when I was ready to push even with the epi.

Now, as for the bleeding thing, it must be low risk. I have a bleeding disorder and I've had 3 epidurals. So I'm high risk to bleed and they still do them.

Having said all of that, I don't advocate for them. If my babies would descend without them, I wouldn't get them. And I go into each birth with the intention not to get them, I only ask after 24 or more hours post rupture of membranes when c-section looms. With my last delivery, I had many of the awful side effects they warn you about: low blood pressure, high temperature, and poor vitals on the baby. I ended up with an internal contraction monitor and an internal fetal monitor, which I hated.

There is no need for you to go into labor with the intention of getting an epidural unless you want that kind of delivery. I'd go over it again with your doc and clarify, because they can get that thing in pretty darn quick in and emergency situation, which is extremely rare unless your doctor is cut happy.

[Terrilein]

I'd avoid it or keep it low if possible. I had an epidural with my first pregnancy and never felt the need to push and was directed when to push instead. It was very frustrating and I pushed for over two hours half sitting and nearly had an emergency c/s. When everyone finally left me and my mw alone to prepare the c/s I turned somewhat to my side and managed to press her out on my own. And that despite a failed vacuum extraction and fundal pressure!

[kittywitty]

I agree with the other posters. That sounds like a hokey reason for an epidural. With my intrathecal, I felt no urge to push and he came out without me doing anything to cause or stop it consciously (the nurse "held him in" to wait for the doc ).

[Lauren31]

Originally Posted by mizznicole

I hope some others chime in because I don't see why the epi is necessary. I'm speaking as someone who had an unplanned c-sec. Once we decided it was needed, the did a spinal. Interested in other responses.

: I would SERIOUSLY be asking some questions and maybe consider getting another OB.

[mamabutterfly]

Originally Posted by omshantihi

Would I still be able to get into suitable positions with assistance? Anything a doula could do to help?

As a doula I experienced many moms w/epidurals who were still able to have some control over pushing.

Steps to minimize negative side effects of epidural:
- Wait til after 5 cms to get it (as you said)
- Turn from side to side often so baby can rotate/move into birth canal
- Keep mom cool to minimize maternal fever (which can lead to baby's fever & cause nicu separation)
- Wait as long as possible before pushing (at least +2 station for example)
- Consider turning medication down for pushing

With assistance of your partner and/or doula, you could push at least on your side, or even on a squat bar - I've seen this, really!

[Annemarie42]

I had an epidural with my first-- they turned it down when it was time to push, and my husband and our excellent L&D nurse helped me move around quite a bit to help position the baby well (she was posterior). We also had the midwife and a student. With the epi turned down, I could feel an urge to push. I waited until I had that feeling before I began to push (which was about 45-50 minutes).

[etsdtm99]

i would also want to get a 2nd opinion or something..

i had an epidural with both my pregnancies and had no issues pushing with some help holding my legs back (which was apparently a work out, my MIL and DH held my legs, i directed them but could not feel my legs at ALL) i could feel when i was having contractions and the urge to push .. with my first, i did 'labor down' for a couple hours at 10 cm before i felt the urge to push, sitting up would have helped but i couldn't because position changes caused baby's HR to slow.. with my 2nd, things happened much faster.. in my experience the hospital OB/nurses were pretty experienced in helping a woman push with an epidural and gave me more direction than just counting etc.

[angelpie545]

I've had two natural births and one hospital birth with an epidural. I didn't notice much of a difference in feeling the urge to push as my I carry all my kids pretty low, although it was hard to tell "where" to push with my medicated birth. However, having the experience of natural childbirth I could remember where to push and did so effectively. Hospital nurses are usually very experienced in coaching women who are medicated to push effectively, so that's a plus. Also having someone hold your legs helps, or having something to push your legs on. For me pushing on my back was ridiculously harder than sitting up, so if you can have your epi turned down a bit and be in a semi-sitting position, that helps.

[MamaMonica]

Moved to Birth and Beyond

[caned & able]

Originally Posted by kittywitty

I (the nurse "held him in" to wait for the doc ).

I did not know that was still done.

That can cause brain damage and oxygen deprivation in a baby that is ready to be born and breathe...! Hospital personnel know that!

[Joyster]

I had an epidural with my first. I don't know what they did, but I certainly felt the urge to push with him. They also had me turning side to side frequently, I did push on my back, but I only had about 20 minutes of pushing.

[hollytheteacher]

My experience of pushing with an epi was horrible.

It took nearly 4 hours of pushing...It hurt so much in everyway but didn't feel like anything was progressing..i just kept feeling ripping/tearing.

I had them shut off the epi prior to pushing but it still was in effect hours after the birth...i had to army crawl to the bathroom after...bleeding alll across the hallway because the nurses didn't answer my call button.

IF there is anyway to avoid an epi during pushing I would. I hope to never have an epi again...I didn't want it last time either but I could write a whole book on all the things that went wrong at my son's birth

[omshantihi]

Thank you to everyone for your suggestions and advice. I'll talk to my ob again about whether an epi is absolutely necessary and how much time it would buy in case of an emergency. Some of you asked what the bleeding issue was. It's not a bleeding disorder, it's a placenta issue. I had a marginal previa until a couple of weeks ago, now it's a very low lying placenta. I'm at 38 weeks now. I haven't had a single bleed or even spotting all through my pregnancy, but my ob says that could change once dilation starts. They're basically worried about adruption (sp?) during active labor and excessive bleeding during placental delivery. I'm fine with getting a pit shot for the afterbirth.