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).
Pet-mom to Squirt with FLUTD & Maya the deaf wonder dog .
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.
Mama to P. born at home 10/09, and W. born in the hospital 2/13
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!
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.
Me 41, single mom to dd 4/2001 and ds 7/17/2010
AP Mom to 5
Would I still be able to get into suitable positions with assistance? Anything a doula could do to help?
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!
Mama to my sweet girls: (2/02) and (2/08) and 3/11 and new baby (5/14)
expecting #3 October 26, 2010
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.
Bethany, crunchy Christian mom to Destiny (11) Deanna (9), and Ethan (2)
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
AP Mom to 5
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.
An epidural is not particularly useful in my experience in the event of a truly emergent c/s anyway. You have to dose an epidural more heavily, which takes time, and I find they usually put you to sleep anyway---so I think you have options if you want them, mama.
Mama to P. born at home 10/09, and W. born in the hospital 2/13
I've had two epidurals during pushing a baby out, and had help the first time around holding my legs up which really helped out a lot. My second was I'm sure outside of the norm in a hospital setting because I waited until she was crowning to push (we knew her heart had stopped prior to labor starting, so the staff was fine with my choice to let my body do the work to birth her) but again it wasn't hard to figure out where to push for me at least.
My second was born a few weeks ago. I was induced due to high blood pressure. I had an epi at 4 centimeters. As I got close to 10 they turned it down or off, and kept asking me if I felt pressure, or an urge to push. They waited until I said yes, I thought I felt like pushing. I pushed 4 times, less than 5 minutes and she was out! Towards the end I was feeling my contractions, lots of pressure and just a tiny bit of pain(they were feeling like very early labor contractions) as the epi wore off. It was perfect, I was feeling enough to push effectively, I felt her moving down and I felt her come out, but I wasn't in any real pain.