If you’re thinking about an epidural for your birth, you may be wondering about pushing during labor with an epidural. It’s actually a question that I get a lot!
It makes sense. I mean if you supposedly can’t feel anything, then how will you push?
Well fortunately, it’s still definitely possible – and in this article, you’ll learn all about how to push with an epidural, epidural pushing positions, and even some tricks to help you if pushing isn’t going well.
You ready to learn? Let’s talk about epidurals and pushing!
Did you know that there are four stages of labor? If not, don’t feel bad! This wasn’t something I knew about prior to becoming an L&D nurse, so consider yourself off the hook!
Pushing is actually the second out of the four stages of labor. This stage begins when you hit 10 cm and ends when you deliver your baby – woohoo!
The length of this stage can vary – I’ve seen mamas push their baby out in one, big push (usually not their first baby) and others push for several hours (don’t worry, this isn’t the norm either).
There are always exceptions to the rules, but pushing normally takes around 2 hours for first-time mamas.
The four stages of labor include:
Interested in learning more about each stage of labor? Check out this article: The Four Stages of Labor
If you receive an epidural during labor you can expect to push a bit longer than the typical non-epidural mama – at least that’s what I typically see.
But remember, there are always exceptions to the rules! And there are definitely some things that you as the laboring mama can do to try and expedite this process.
Simply put, the goal of an epidural is to take contraction pain away. It is normal and expected for an epidural mama to feel vaginal and rectal pressure, especially as she gets closer to the pushing stage and even during pushing.
Well, it would be pretty tough to push a baby out of your vagina if you couldn’t feel a thing, right?
Most mamas that get an epidural during labor expect to not feel a thing. While this is the case for some, it’s actually not the intention.
Rectal pressure actually helps guide mamas how to push and when to push and can decrease pushing time and reduce the potential need for an unplanned C-section. Of course, your labor and delivery nurse will be able to coach you during pushing, but trust me – your pushing will be a lot more productive and effective if you are able to feel something.
Rest assured, if you are one of those mamas that finds yourself with a super dense epidural in labor, don’t panic that you are going to push for four hours or end up with a C-section – there are lots of positions (even with an epidural!) that you can utilize to help increase the effectiveness of your pushing.
When it comes to pushing, there are two very important things that I want you to keep in mind:
I tried pushing on my hands and knees and I hated it! I much preferred pushing on my back, but I know lots of women probably shudder at the thought of giving birth on their back. I tell you this to reiterate the fact that what works for one person doesn’t always work for another. And what works during one birth might not be what works for you the next time.
As an epidural mama, you won’t have quite as many options when it comes to pushing because you will be confined to your bed but here are some that you might want to try.
There might be some minor things that differ when pushing with an epidural, but the overall pushing concepts surrounding pushing apply whether you have an epidural or not.
Ready for a little pushing crash course? Here we go!
When it comes to pushing, I usually let you do what feels best for you at first, and if it’s working, great, keep it going! If not, I usually guide mamas to push using this method:
As a labor and delivery nurse, there are a few tricks we have up our sleeve if it seems that pushing isn’t quite as effective as we want or need it to be.
Like I just mentioned, there are lots of benefits to changing your position during labor and birth.
Changing your position can cause baby to move, wiggle, or change their position, which might help them get into a more optimal birthing position and allow for more effective pushing.
This is likely the first thing I will do if you push for a few contractions in one position and have minimal progress.
We can use this technique if you are 10 cm dilated, but baby’s head is still high and you aren’t feeling pressure. Let me explain.
Typically, what happens with laboring down is we put you on one of your sides with the peanut ball between your legs. The peanut ball is exactly what it sounds like, a ball shaped like – a giant peanut!
The purpose of the peanut ball is to keep your pelvis open, allowing baby’s head to drop into your pelvis easier. In my opinion, it’s a win-win position. You get to “rest”, baby does some work, and you push for less time!
Maybe game isn’t the right word, but let me just explain what I mean by this. Have you ever heard of someone playing tug of war during labor? It’s a great technique that can be used to add a little power to your pushes!
Here’s how it works:
I’ve seen this work wonders for some women and then I’ve seen others that try it once and hate it. I recommend trying it for a couple of contractions and switching to something else if it doesn’t seem to be working!
Some women are just so numb from their epidurals that they can’t feel a thing. Remember, the goal of an epidural is to take away contraction pain but not to take away rectal pressure as baby moves lower into your pelvis.
Some women respond well when their nurse or provider puts gentle pressure inside the vagina to help direct pushing efforts.
Their fingers do not need to be in there the entire time – sometimes it just takes one or two pushes to get the hang of it.
Okay so this isn’t something that’s done often, but if we have exhausted all other interventions, we can, with the guidance of the anesthesia provider, turn your epidural off.
This might be for the remainder of your labor, or it might just be briefly until you feel enough pressure in your vagina and/or rectum to be able to effectively push!
When we do this, it’s one of our last-ditch efforts to help you push baby out and avoid a C-section.
That really depends on how dense your epidural is, but you are likely to feel something at some point during the pushing phase whether or not you have an epidural – I mean, you are pushing a big ole baby out of your vagina, after all!
Are there women that go through the entire pushing stage without feeling an ounce of pain? Absolutely! But is this the norm? Absolutely not! I don’t care what your friend or your sister or your neighbor has told you about their own birth experience, an epidural is not meant to take away 100% of your pain during labor and birth.
Have I mentioned that enough already? Just want to make sure you have a realistic expectation!
Maybe it won’t, but more than likely you will experience some degree of discomfort or pain, hopefully only in the way of pressure, while pushing your baby out, even with an epidural.
You can also expect the pressure sensation to become more intense as baby gets closer and closer to coming out – most women describe it feeling like the baby is coming out of their butt.
If you’ve never heard this before then consider yourself warned. But really, I’m all about setting realistic expectations and am not in any way, shape, or form trying to scare you. The more you know, the more you know, am I right?
Along the same lines as “does it hurt to push with an epidural” is the question of whether or not you will feel the ring of fire with an epidural. The short answer to this question is it depends.
Maybe you will feel the ring of fire when pushing with an epidural and maybe you won’t – there’s no way to predict it ahead of time as each epidural placement is different and unique.
You might be asking yourself what is the ring of fire? As baby’s head is crowning, you might feel what is commonly referred to as the ring of fire. This happens as a result of the skin around your vagina and perineum stretching to allow for baby to pass through.
While it is most common for mamas without epidurals, some epidural mamas do report feeling the ring of fire as well. Many report it feeling like a burning or stinging sensation in their vagina. Rest assured that this part of the birth process is VERY short-lived compared to your whole labor.
There are a couple of ways you can approach the ring of fire:
It can definitely be hard to prepare for how you will handle this situation, should you experience it, until you are in the actual moment, but it’s something good to keep in mind.
Now that we’ve covered the ins and outs of pushing with an epidural, including the pushing stage of labor, productive labor positions with an epidural, what to do when pushing isn’t going well, and how much pain you can expect to feel when pushing with an epidural, I hope you find yourself adequately prepared for what pushing with an epidural looks like.
There is a misconception that women with epidurals can only push on their backs, but that is far from the truth. While you will be slightly more limited with an epidural in place – having an epidural does not mean that you must push lying on your back.
I encourage you to break down this misconception with anyone that tells you otherwise, now that you are an expert.
To learn more about epidurals, including when to get an epidural, how an epidural works, and epidural side effects, I encourage you to check out some of my other resources below.
My online birth class, Birth It Up: The Epidural Series course covers all these topics and so much more so definitely check that out and feel free to shoot me a message if you have any further questions (IG handle: @mommy.labornurse).
You can also learn more on the blog and podcast:
Cheers to an even better birth, mama!