An epidural is a regional anesthetic delivered through a thin catheter placed into the epidural space of the spine, which numbs the nerves that transmit pain signals from the lower body. This form of pain management is highly effective during labor, allowing for rest and relief from the intense discomfort of contractions. The goal of the medication is to block the sensory nerves responsible for pain without completely eliminating all physical sensation or motor function. Understanding how the epidural interacts with the pushing phase can help manage expectations during the final stage of childbirth.
Pressure Not Pain The Core Sensation
The primary sensation during the pushing phase with an effective epidural is intense pressure, not the sharp, searing pain of contractions. This pressure is caused by the baby’s head descending deep into the pelvic floor, specifically pressing against the rectum and the sacral nerves. Many people describe this feeling as an overwhelming, urgent need to have a large bowel movement, which is the body’s natural reflex to bear down.
The epidural medication is designed to block pain signals, but it often spares the larger nerve fibers that transmit deep pressure and touch sensations. These deep pressure receptors continue to send signals to the brain, providing physical feedback that the baby is moving down.
The level of pressure felt can vary depending on the medication concentration and catheter placement. Even if contraction pain is gone, the physical displacement of tissues by the descending baby creates a mechanical force the epidural cannot fully block. This retained sensation of pressure is beneficial, as it guides when and how to push, even when the natural urge is muted.
Techniques for Effective Pushing
Since contraction pain is blocked, the body’s reflexive pushing urge may be lessened or absent, requiring guidance from the care team. This is known as “coached pushing,” where nurses or doctors direct the timing and effort based on monitoring uterine contractions and the baby’s position. The pushing phase with an epidural often involves deciding between two primary techniques: directed pushing or spontaneous pushing.
Directed pushing, sometimes called “purple pushing,” involves taking a deep breath, holding it, and bearing down hard for a count of ten during a contraction. While efficient, prolonged breath-holding can lead to maternal fatigue and may reduce oxygen flow to the baby. For this reason, many providers now favor a more nuanced approach.
Spontaneous pushing, or delayed pushing, involves waiting until the mother feels a mild urge or pressure. This approach encourages shorter, more frequent pushes with open-glottis breathing, where air is slowly released during the effort. Allowing for passive descent, where the baby moves down the birth canal without active maternal effort, conserves energy and is often associated with better outcomes.
Mobility is often limited with an epidural, but medical staff assist with positions that optimize the pelvic outlet. Instead of lying flat, positions such as side-lying, using a squat bar, or semi-reclined with legs positioned to open the pelvis can be used. Changing positions helps the baby navigate the final turns of the birth canal, maximizing the efficiency of each push.
When Sensation Varies Hot Spots and Incomplete Blocks
While epidurals are highly effective, variations in sensation during pushing can occur. One common variation involves “hot spots,” which are localized areas where the anesthetic solution did not fully spread, resulting in breakthrough pain. These spots often manifest as sharp, burning sensations concentrated on one side of the body or specifically in the vaginal or rectal area.
An inadequate block can occur if the catheter shifts or if the medication concentration is too low. This can lead to a strong, painful urge to push that is much closer to unmedicated labor, particularly in the lower sacral segments. The sacral nerve roots, which supply the perineum, are larger and more difficult to block fully, leading to a phenomenon known as sacral sparing.
If unexpected pain or a strong, painful urge is felt, communicate this immediately to the medical team. The anesthesiologist can often administer a supplemental dose of medication, known as a bolus, through the existing catheter to strengthen the block. If the problem persists, the catheter may need to be repositioned or, in rare cases, replaced entirely to achieve a more complete block.
Immediate Post-Delivery Sensations
The moment the baby is born brings an immediate sensation of relief, as the intense internal pressure abruptly dissipates. The physical space previously occupied by the baby’s head is instantly vacated, resulting in a feeling of lightness and emptiness in the lower abdomen and pelvis.
Even with the pain relief provided by the epidural, many people still feel the physical sensation of the baby exiting the body. This feeling is not typically painful, but rather a powerful, stretching sensation or a rush of warmth as the baby moves through the vaginal opening. This physical awareness allows the mother to feel the final passage of the baby without the associated pain.
Following the delivery of the baby, the final stage of labor involves the delivery of the placenta, which usually occurs within a few minutes. This is generally a painless process, involving only mild cramping or pressure as the uterus contracts to expel the organ. After the placenta is delivered, sensation and motor function will begin their gradual return, often starting with a tingling feeling in the legs and feet as the anesthetic effects wear off over the next few hours.