Tips for giving birth successfully if you choose to labor with an epidural.
The majority of women in the United States today opt for epidural analgesia during labor. In fact, the epidural rate in some hospitals tops 80-90%. Evidence is mixed about whether or not epidurals cause an increase in the cesarean rate, however epidurals nearly always bring additional interventions into the birth. Some of these interventions include IV’s, urinary catheters, pitocin and instrumental deliveries. If mothers plan to use an epidural, how can they minimize unnecessary medical interventions? Here are some helpful guidelines:
Delay getting epidural analgesia until you are about 5cm dilated (or active labor), contractions are strong and regular, the baby is at zero station (engaged) and fully rotated into the anterior (OA) position. If the baby has not descended well within the first 30 minutes of pushing (ask the nurse to assess) then do the following:
Change positions – try side-lying, all-fours, lying at 30 degree angle with feet on squat bar or squatting (only if you can support yourself) with two support persons for help if possible. Change positions every 30-45 minutes until baby begins to descend.
Avoid doing the following:
1. Pressing the mother’s legs back too far toward her shoulders when you are helping her push; this can cause nerve damage.
2. Pushing when the baby is still high in the mother’s pelvis. (above zero station.)
3. Pushing when the baby is OP (posterior.)
4. Holding your breath for longer than 6-8 seconds with each push. This is called purple pushing and has been shown to be harmful than helpful in the second stage of labor.
5. Getting into the stirrups position when you begin pushing.
Use the towel method – tie one end of a bath towel or sheet to the end of the bed or give to a support person and give mom the other end. During contractions, have mom pull (as in tug-of-war) on her end of the towel as she pushes. This helps her use her abdominal muscles when pushing.
Have the nurse, midwife or obstetrician place two gloved fingers inside showing her where to push. Ash her to “push the nurse/doctors’s fingers out.”
Consider reducing the epidural even further or possibly shutting it off.
Use a mirror when baby’s head becomes visible to motivate mom.
Request a “light” epidural from the anesthesiologist, if possible. This will allow you to feel contractions but not pain.
If you have been in labor for a long time, use the time after getting an epidural to rest. Ask visitors to leave and ask the nurse to turn down the volume on the external monitor so you can sleep. This is the best way to conserve energy for the pushing stage.
If you can feel your contractions and move your legs, you might be able to empty your bladder using a bedpan instead of a urinary catheter. Ask the nurse if you can try this and be sure to empty your bladder before you begin pushing.
Delay pushing until your baby is about +2 or +3 pelvic station,(otherwise known as “laboring down”)* or you have a strong urge to bear down.
*THE BENEFIT OF “LABORING DOWN”:
A study of over 1800 women in 12 locations found that when mothers reached 10 cm, they benefitted from waiting before pushing if their babies were still high (baby was above zero station/engaged) or were posterior. (Fraser et al, Obstetrics and Gynecology, 2002)
Do you plan to use an epidural? Share your ideas why or why not?