Many considering an epidural for pain relief during childbirth wonder about its effect on the pushing phase. A common concern is whether it will prevent effective pushing or alter the sensations needed to guide the process. Understanding how epidurals interact with labor mechanisms clarifies how pushing can still be successful.
How Epidurals Affect Labor Sensation
An epidural involves injecting medication into the epidural space in the lower back. This regional anesthesia blocks nerve impulses from lower spinal segments, providing pain relief from the midsection down. While alleviating contraction pain, an epidural typically allows the individual to remain awake and aware.
Sensation with an epidural varies; some experience near-complete loss of feeling, while others retain movement and pressure sensation. The medication reduces pain but often preserves pressure sensation, which aids pushing. Epidurals can lessen the natural urge to push by numbing the nerves in the cervix and pelvic tissues that signal the body to push.
Techniques for Pushing with an Epidural
With reduced sensation from an epidural, individuals may not feel a strong urge to bear down naturally, making healthcare provider guidance valuable. One common method is directed pushing, also known as Valsalva pushing. This involves taking a deep breath, holding it, and bearing down forcefully for about 10 seconds, repeated three to four times during a contraction under guidance.
Another method is laboring down, or passive descent. This delays active pushing for one to two hours after full cervical dilation, allowing the uterus to continue contracting and the baby to descend naturally. This approach conserves energy and can shorten active pushing duration. Delayed pushing is a common practice in hospital settings for those with epidurals.
Spontaneous pushing, where the individual follows their body’s inherent urges, is also a possibility, though it requires more heightened awareness of subtle sensations. While less common with a dense epidural, some individuals may still feel enough pressure to push instinctively. Healthcare providers support these efforts by observing physical cues and offering encouragement, helping to translate the body’s subtle signals into effective pushing.
Supporting the Pushing Process
Even with an epidural, positional changes can significantly enhance the pushing phase. While pushing on the back is common, alternatives like side-lying, hands and knees, or a semi-seated position can open the pelvis and utilize gravity more effectively. Nurses and support staff can assist with these position adjustments, often using tools like peanut balls to optimize comfort and fetal descent.
Healthcare providers offer verbal cues and encouragement, especially when natural sensations are muted. They may also provide gentle external pressure or internal guidance to direct pushing efforts. This feedback helps focus energy. Adjusting epidural medication is another strategy; a lower dose can allow more sensation to feel the urge to push, or the epidural can be temporarily reduced, though this process may take time.
Common Experiences and Outcomes
Pushing with an epidural is a frequent and generally successful part of labor and delivery. While the second stage of labor may be somewhat longer for those with an epidural, often by about 15 to 20 minutes, this does not typically increase the likelihood of needing a C-section. The ability to rest and conserve energy during the first stage, thanks to pain relief, can contribute to a more effective pushing phase.
Many describe feeling pressure rather than pain during pushing with an epidural, a sensation that guides their efforts. While the intense “ring of fire” sensation at crowning may be diminished, some may still experience it. Epidurals are a widely used pain management option, allowing many individuals to have a successful vaginal birth while remaining comfortable and engaged.