I'm going to really try to go w/out an epidural, but I just wanted to know your experiences---just in case. What is the best position to push in w/ an epidural? I've heard on your back isn't very good, but what are the options? Thanks
Really, with an epidural, most practitioners will just put you in lithotomy position -- it seems to take a very alternative practitioner to allow an epidural mom to push any other way.
One time only have I seen a epidural mom push with a squatting bar, per midwife's instruction, but she had her husband and two doulas to help with her very numb leg (epidural only took on one side). The nurse was not happy AT ALL! She kept questioning if that was okay to do as she was worried about damaging a limb the mom could not feel.
The other epidural clients I had had doctors, not midwives, and the doctors just preferred mom to assume the position.
Talk to your practitioner and see what he/she allows.
How have you been preparing for this birth mentally? Normally I would not ask, but since you mentioned you are going to try to go without the epidural, I am just curious? IMO, mental preparation is over 95% of the deal -- a woman who is prepared mentally has a much greater chance of having the birth she pictured.
I've prepared by reading everything I can, webster technique chiro to try to get baby in good position (she's roa now and higher chance of going posterior, which I had last time and hurt like crazy and ended up c/s), we took Bradley classes the first time also, pelvic rocking etc., doula RN who has lots of homebirth experience and a good doctor. I don't know of anything else to do! I'll do it if it's recommended.
The only problem with side-lying for an epidural patient is that the epidural tends to become stronger on the dependent side and wear off on the upper side. The people in my experience who have the most pain in labor are not folks without medication, but folks with a poorly working epidural. I think maybe because they are so expecting relief, that it's even more discouraging to have pain after an epidural is placed.
Depending on how numb mom is with the epidural, upright position can be used. We use hands and knees still a lot. We usually have mom kneel on the bed and rest her arms over the top of the bed with the bed up almost in a chair position. We also have had many moms squat with the epidural if they have at least a little movement. I'm not crazy about squat bars, though. What I do is lower the feet all way and have mom sit up at the edge of the bed (this is the type of bed that breaks down for delivery.) Then when a contraction starts, we help mom lean forward and squat on the foot of the bed, then help her back to sit on the edge between. This works great if there is a nice strong dh type around, and a helpful doula type, too. Otherwise I wear the nurses out (which at least in my hospital they are willing to help holding someone in a squat, but you might not find such nice nurses elsewhere.)
You have to be careful to hold onto the mom with an epidural, especially if she is pretty numb. Also, you can turn the epidural off for pushing, usually, and then turn it back on if you have to proceed to operative delivery of some type.
Pushing is much easier if you can move freely, though, so avoiding the epidural altogether makes it easier.
Some anesthesiologists also prescribe bedrest for all epidural patients and will not allow any other positions, so you might want to check that out in advance.
Jen is correct in that even with epidurals the nurses at our local hospital encourage moms to rotate sides every 30 minutes to keep the dispersion of medication more even.
MommyDOK, you sound well-prepared. My favorite book to recommend is Birthing From Within, especially for a mom who has had a traumatic/less-than-ideal prior birth. Other than that, for where you are I might have you check into hypnobirthing.
My second baby was posterior, and he did deliver eventually, vaginally. And ye-ouch! It was pretty bad, but I was able to get through it, luckily, but mostly because no one knew he was posterior until the very, very end.
The problem is that it doesn't wear off evenly. Moms tend to develop hot spots on the upper side, and often then feel even more pain in that one area. You can rotate moms from side to side, though, as a PP suggested, to prevent that from happening. I find that moms with a "hot spot" tend to have an even harder time pushing than a mom with dense epidural - I think the epidural does something to your normal ability to tolerate pain.
Originally Posted by doctorjen
I think the epidural does something to your normal ability to tolerate pain.
I won't even pretend to understand painrelief more than you, Jen, so correct me if I have wrong information. When I was training to be a doula, I was told that when you get pain relief your body stops producing its own endorphins. So when the pain relief wears off, you feel the pain w/ no "buffer" of natural endorphins, which causes even more pain than would have naturally occured. Did that make sense, and is it true that you know of?
I had two epidurals and delivered both on my back in stirrups. Not ideal for pushing but the babies came out just fine. I got an episiotomy with Abi because her heart almost stopped a couple of times, they wanted her out faster. Basically a c/s down there. Nitara came out practically on her own. She moved down to the opening on her own and just a few (three I think) pushes and she was out. I had one tiny tear to the side from her head not coming out straight, but didn't need any fixing up.
Both epidurals worked great, no complications, no need for pitocin or other things. However with Nitara's birth I was lying on my side and started to feel the epidural move up towards my diaphrame. I got a feeling like I was about to have an asthma attack. Very mild but since I have asthma I picked up on it right away. My doula suggested sitting upright and within a few minutes I was fine again. I never told the nurses about it because I was afraid they would overreact.
Are you planning to have a doula present? She would be able to help you focus on the birth and avoid the epidural if you really don't want one. I did want one, I already had decided in advance. I have good personal reasons for wanting one.
I think there is some evidence that regional anesthesia does interfere with the body's own ability to cope with pain. Also the times I have seen moms develop hot spots, they seemed to feel more intense pain in those areas, and the pain was not easily relieved by many of the non-drug techniques I would use for labor pain relief (position changes, massage, breathing, heat, etc.) I've had better luck either turning it off and using other pain relief methods, or having the epidural restarted.
I have seen many moms push their babies out just fine with an epidural, but it can definitely prolong the second stage, so if possible using a more upright position really helps.
I had an epidural that had mostly worn off by the time I was pushing, but I still could not stand on my own. My midwife had the bed cranked so that I was nearly sitting up, and broke away the end of the bed for delivery, so my tush was pretty much at the edge. Then I had my legs up as though there were stirrups, but there were not. A nurse had her hand under one of my knees, and my dh had his shoulder under the other (I believe his back was to me, but I also think my eyes were closed most of the time I was pushing). I braced one foot against dh's hand and the other against my mw's shoulder. There were handles under the bed, or bars or something, on either side of me around hip level, and I remember pulling up on them while I pushed. Boy, were my shoulders sore the next day!
I felt really good pushing this way -- had no desire to change positions.
FWIW, I experienced the epidural as a fuzzy feeling. I had sensation -- my contractions with the epidural felt like braxton hicks contractions, just pressure with no pain, but I could definitely feel them. I joked that it was like being stoned from the waist down. I would much rather have the next baby with no medical pain relief, but I don't regret my decision during my dd's birth -- I was so tired, and the epidural gave me a few hours of respite to "regroup" before pushing.
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