# is pushing more effective without the epidural?



## misscyn

I'm currently pregnant with #2 and i'm weighing the pros and cons of the epidural. I took it with dd and although my delivery was quite painless, recovery was difficult. Also, they needed to use the suction to get dd out even though she was only 7 lbs and had a small head. Well I just assumed this was because I have narrow hips, but it was recently brought to my attention that the pushes may not be as effective with the epidural because you're not pushing when your body is telling you to. Does anyone know if there is any truth to this? Maybe someone who has experienced both a natural birth and one with epidural? Thank you!


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## NDH

Pushing is definitely more effective when youre in a position other than lithotomy. Not having an epidural means youre free to find other more effecrive positions and have gravity help. Hands and knees, squatting, sifting on a birth stool, etc.


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## cncem

I had an epi with both of my previous pregnancies, and both times the doctor had to pull the baby out with forceps because I could not or was to exhausted to push. My daughter was 7 pounds 11 oz and my son was a preemie at 35 weeks and 4 pounds 11 ounces. My ob asked me why the doctor had to use forceps both times, and said they shouldn't have had to use them with my son as he was so small. I didn't want to admit that maybe the epidural was the reason, but I've wondered about that. I will opt for an epi this time, despite my experiences because I'm a wimp and don't want to feel all that. I own that though.


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## purplecupcake

Didn't have one but I would say yes. I loved being able to feel how hard to push, I think it definitely helped prevent tearing - I only needed one stitch. Feeling his head pop out was so cool!


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## ClairAye

I've had both and although my first was generally much worse than my second, he was forceps and my DD was a SVD, she was the first time I felt everything with pushing so I would say yes.


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## misscyn

Thanks ladies,
I'm going to aim and prepare for a natural birth this time. I've been reading up on it and it does seem that the epi leads to higher rates of forceps and suction. Also I got an anal fissure last time (sorry tmi) which took 2 years to heal, and I read that may also be linked to the epi.


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## ciz

i was in labour for 5 days with my first. very slowly labour. when i was finally 5cm gone i screamed for a epidural and gas&air. 6 hours later i was fully and 20mins of pushing and she was born no forceps etc. i did have tearing but i was stitched up well. a friend told me to add afew drops of tea tree oil to my baths and i healed up very quickly


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## MummyToAmberx

Yes without a doubt, plus not being on your back is even more helpful.


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## BunnyN

I had a big baby and long labour but actually loved the pushing part. I'd hate not being able to feel what was going on. I had a very quick recovery and was hardly sore after. I don't know what it would have been like with an epi but I think being able to feel what was going on and control it did help.


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## Hannahboo

I think it hinders your ability to push, with the epi the drs tell you when and how long and even how hard to push. Without pain meds your body tells you what needs to happen and your body knows best since its the thing dealing with it.


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## ItsJana

I can only say from my experience. I had an epidural with my 2nd DD, and for some reason it worked better on my left side than the right side. I could still feel contractions on both sides though (although very muted) and didn't have trouble pushing. I was a VBAC so it was my first vaginal birth, I had two stitches and for me the epidural was worth it. This time I would like another epidural and can only pray it goes as well as last time.


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## Eleanor ace

Yes having an epidural makes pushing less effective, it is one of the things listed in the "what to consider when choosing pain relief" leaflet we get at my hospital. Not being able to feel the urge to push, or having reduced feeling makes it harder to push effectively and to make the most of each contraction. Your chances of having an assisted delivery are increased with an epidural. It isn't a given though and if you are able to get a walking epi that would help your chances of having a better pushing stage as you wouldn't have to deliver on your back.


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## Tigermom

I agree with what everyone is saying. Although, at my recent visit to L&D, they have had a change in policy that even those with the full epidural will lay on their side for delivery (fetal position, kind of). It allows that sacrum to swing back and give the baby more clearance through the birth canal while giving mommy and baby much better circulation as well... always helpful. 

My epidural took the pain away, but I could still feel the contraction, so I knew when to push. However, I pushed for 2.5 hours, and the recovery was miserable. I'm doing my best to avoid it this time, but I will not beat myself up if I give in. Still... preparing to not get one!!

I hope this helps!


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## tinymumma

At my hospital, the epidural given is called a "mobile epidural" You can still move into different positions but you have to stay on the bed. My midwives told me that with any kind of spinal drug, there can be chances of needing interventions due to ineffective pushing. However, my epidural failed, so they gave me a spinal block, which is complete numbness and lack of control from the chest down. It wasn't what I wanted at all (I didn't even want an epidural) but due to the length of time I was in labour, it was what needed to happen for a safe delivery for my son and myself.
Even with the spinal block, I pushed him out all by myself. No forceps of vaccum, I didn't even need to be cut. 
Anyway, it just really depends on what kind of epidural you get. A mobile epidural you can feel pressure, so you can push when your body tells you, or the epidural given where you feel absolutely nothing. It really depends on your hospital, state and country as to what epidural is used. Ask your midwife what is given at your hospital :) But even if you get the full epidural/ spinal block, I'm living proof you can still push that LO out all by yourself with out interventions. You do need to be told when to push though


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## vickyandchick

I had an epidural but I was so delirious on pain that I don't even remember what happened other than that I started needing to push just after it was done and he arrived about 3/4 pushes later- my body just did what it wanted and the epidural made me progress from 4 to 10cm in about half an hour after being stuck for 6/7 hours at 4. I may be the minority but it actually helped me loads:flower: x


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## Betheney

You can still have an effective pushing stage with an epidural, many women will tell you they are proof of that. 

But having the epidural definitely decreases the chances of it. Of course pushing is going to be more effective if you can move around and aren't numb from the waste down.

I've had 2 births with no epidural and I love pushing! 

Getting an epidural also means no more walking around so if your baby turned out to be posterior anything yo7 could of done to encourage baby to turn will not really be an option as you lay flat on your back a position that posterior babies tend to feel comfortable in.


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## messica

I personally think the let's blame the epidural for every problem on the planet is a junk blanket opinion put out there in an attempt to scare women (for a multitude of reasons) not to seek pain relief (not saying anyone's done that here - just in general). 

I've had two. Will definitely have one this go round too. I was still 100% mobile (walked, labored in shower, used birthing ball and squatting bars) and had absolutely no trouble pushing extremely effectively. I had no assistance delivering and no post partum problems. No other women I know has either. It's actually joked about - the massive discrepancies. Like urban myths actually. "OMG - this one lady I heard had an epidural and she couldn't walk for DAYS!!!" or "My sisters friend's boss had an epidural and she couldn't pee normally for the rest of her life!!!"

That's just not how they function. 


If your epidural is administered properly by the anesthetist, and you're treated with care by labor support staff who know what they're doing, trouble's with epi efficacy and pushing are rare at best. They can be turned up or down at the drop of a hat and are very easily controlled if placed correctly. Mine merely took the edge off my pain. I still felt everything just fine. I was up within a half hours time (had to deliver placenta and nurse first) to pee all by myself.

As with anything involving prenatal care and the delivery of one's child, the best advice is always to choose experienced personnel, and really know how to advocate for yourself by being educated about all options and procedures. If I'd have been told that having an epidural meant I'd be flat on my back I'd have laughed hysterically, and then went on to deliver elsewhere. That's simply not how they're meant to be utilized and it's definitely one of the biggest reasons they fail - so why would I allow myself to be subjected to that??


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## BunnyN

messica said:


> I personally think the let's blame the epidural for every problem on the planet is a junk blanket opinion put out there in an attempt to scare women (for a multitude of reasons) not to seek pain relief (not saying anyone's done that here - just in general).
> 
> I've had two. Will definitely have one this go round too. I was still 100% mobile (walked, labored in shower, used birthing ball and squatting bars) and had absolutely no trouble pushing extremely effectively. I had no assistance delivering and no post partum problems. No other women I know has either. It's actually joked about - the massive discrepancies. Like urban myths actually. "OMG - this one lady I heard had an epidural and she couldn't walk for DAYS!!!" or "My sisters friend's boss had an epidural and she couldn't pee normally for the rest of her life!!!"
> 
> That's just not how they function.
> 
> 
> If your epidural is administered properly by the anesthetist, and you're treated with care by labor support staff who know what they're doing, trouble's with epi efficacy and pushing are rare at best. They can be turned up or down at the drop of a hat and are very easily controlled if placed correctly. Mine merely took the edge off my pain. I still felt everything just fine. I was up within a half hours time (had to deliver placenta and nurse first) to pee all by myself.
> 
> As with anything involving prenatal care and the delivery of one's child, the best advice is always to choose experienced personnel, and really know how to advocate for yourself by being educated about all options and procedures. If I'd have been told that having an epidural meant I'd be flat on my back I'd have laughed hysterically, and then went on to deliver elsewhere. That's simply not how they're meant to be utilized and it's definitely one of the biggest reasons they fail - so why would I allow myself to be subjected to that??

It is certainly worth asking if a 'walking epidural' is available as that can be quite a different experience. Where I live a walking epidural is not an option. An epidural pretty much means lying on your back with no feeling from your waist down. In some places there are more options so it is worth to find out. Of course walking epidurals don't work out for some people it is possible that you will still end up not being able to walk but that is only a minority of the time.


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## dani_tinks

I'd say so yes. I had an epi with my son and I found pushing very difficult as I couldn't feel my contractions, therefore had no idea when to push. It took me just over 3 hours!


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## NDH

https://summaries.cochrane.org/CD000331/PREG_epidurals-for-pain-relief-in-labour

https://summaries.cochrane.org/CD00...-epidural-versus-epidural-analgesia-in-labour


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## messica

BunnyN said:


> It is certainly worth asking if a 'walking epidural' is available as that can be quite a different experience. Where I live a walking epidural is not an option. An epidural pretty much means lying on your back with no feeling from your waist down. In some places there are more options so it is worth to find out. Of course walking epidurals don't work out for some people it is possible that you will still end up not being able to walk but that is only a minority of the time.


See, where I'm at an all or nothing one time bolus would be called a spinal. They are intended to take away all feeling and only last a set amount of time. 

An epidural however, (or walking epidural if it's easier to understand but really there is no difference save for additional monitoring and period adjustments) is a catheter that delivers medicine no different than an IV does. With an IV in your hand or arm your nurse can completely nip the tube, set it at a slooooow trickle or push a giant bolus dose into your body. The amount of medication pushed and the rate at which it's delivered is completely controllable. With an epidural, the catheter is no different in concept. After the initial test dose it can be turned all the way down, set at a trickle, or push a bolus dose that completely numbs everything for the duration of delivery. It should all be completely adjustable throughout. 


If a woman ends up being able to feel so little that she can't even push effectively, then either labor progressed too quickly for medical personnel to turn it down, or they weren't adequately trained on how to use the pain management most effectively. I don't know of many who would consider not even being able to feel the need to push and use of subsequent interventions like forceps - a successful or normal utilization of an epidural (save for times when they need to be jacked up for csections). 

Uneven distribution is the result of being cranked up too high or not moving around enough. It always makes me sad to hear women who experience the one sided effect. I can just imagine them laying there on back or side with medicine pooling not doing them much good. That's just not how it's supposed to be. Same goes for a "walking" epidural. If legs start to go the fix should be as easy as turning it down.


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## NDH

Epidural means the needle and medication (local anaesthetic) goes in the epidural space between the spinal fluid. 
A spinal is when the needle and medication (generally an opiod) goes directly into the spinal fluid. 
Its the location that matters for the definition as the type and strength of the dose can change.

A walking epidural is usually a CSE or combined spinal epidural where you get a low dose local an anaesthetic and an opiod administered at the same time. 
They're not very common outside the US and almost unheard of here in Australia.


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## BunnyN

The epidurals available where I live should be able to be turned down so as to feel a bit better for pushing but you are still not alowed/able to walk during the epidural or for some time after. In theory positions like lying on your side or even hands and knees should be possible but you'd have to be pretty insistant with hospital staff if that's what you wanted. Mostly it is assumed you will stay on your back. In some hospitals in some countries they are starting to make different positions standard for an epidural even when you can't walk.


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## misscyn

This website is the only place I've ever heard of a walking epidural. It was not mentioned to me during labour with my daughter, and I don't know anyone who's had one. So I'm guessing it's not something that is routinely available here. For me, epidural means you're completely numb from the waist down. Anyway I have an appointement with my doctor on Friday and I will def inquire if this is something I can request, although my plan A is still to try to go natural. Thanks ladies for all of your clarifications.


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## Spudtastic

I'm currently pregnant with my second and would like to try for a natural birth. However if the circumstances are the same as dd then I will have an epidural. Dd was facing the wrong way. It was a long slow very painful labour. At 4 cms my midwife said I had at least 9 hours to go and I wasn't getting any break between contractions. Contractions had been long painful and very close together for 7 hours already and contractions had started a few days before . She suggested an epidural. I had told her I didn't want an epidural but she told me she would suggest I have one if she thought I needed it. By the time pushing came I was rested and was able to push. I had the strength to do it whereas I don't think I would have without the epi. Yes, I did make my midwife have her hand on my tummy and tell me when to push because I couldn't feel the contractions. Because dd turned whilst in the birth canal it was still v v painful even with the epi. 
I pushed for 1 hr 50 minutes. There was no intervention though I did have an episiotomy because my perinium is quite large (tmi).


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## dairymomma

I've had 2 natural births and one birth with an epidural. Overall, I'd have to say the epi didn't hinder my pushing ability one bit even though I couldn't feel anything during delivery. The nurses turned down my epi when the dr broke my water but I progressed so fast after, the epi didn't have any time to wear off before I pushed. With my natural births, it took 3 pushes (10 minutes) and 5 pushes (20 minutes) for my kids to be born. With my epi delivery, it took 1 push and less than 5 minutes for DD to be born. The dr was watching and he told me when to push. Yes, I know there's increased risks and all that but I can honestly tell you that just because there are those risks, doesn't mean it'll happen to you.


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## Anh1982

I had an epidural and couldn't feel a thing, but was able to push just fine, no suction or forceps. I had one small tear but I had no pain at all after delivery. I'm going to have an epidural again this time and hope for the same results!


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## mysweetangel

I just had my first 2 months ago and had an epidural. I had her out in 3 sets of pushes (20mins) :)


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## nikkchikk

I had an epi and I had no issues. But my epi also wore our a few hours before and i didn't ask for more when it was time to push. I had no problem pushing, as the nurses looked at my contractions and told me when to do it. Matched spot on with the pressure I felt as the contractions came on


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## MommyJogger

I had an epidural with my first and pushed for a very long time. I wasn't able to feel anything and did a lot of "purple" pushing, with the nurse jabbing me somewhere in the nether regions, demanding I "push to here" even though I was numb and had no idea where she was poking. 
I had a home birth with my second and I highly recommend the intervention-free route. It felt quite good to push and took little effort, my body just did it on its own and recovery was much better. I could not have enjoyed laboring more than I did with my second baby without feeling overwhelmed by pitocin and then handicapped by the epidural.


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## Kitteh_Kat

I had a wonderful epidural and had no problems pushing. The nurse actually complimented me! I had been able to get some sleep because I was pain-free and comfortable, so had plenty of energy and focus for that stage. Definitely was a great birth experience! :flower:


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