Pushing with Epidural

GET A DOULA! Seriously - I loved mine, best thing I did. Even my husband, who was skeptical, has told every expectant father since to, "just get the damn doula."

I had epidurals with both of mine and with both I was the one that told the nurse when I needed to push. I don't know what purple pushing is. You can't move into other positions with the epidural but it's very easy to push - the epidural just numbs pain, not pressure, so you still feel what you're doing and the pushing is just like pushing out when going #2, just harder and more intense.

Why is your OB wanting a C/S? What are the risk factors? If it's likely that you will need a C/S then you should get the epidrual otherwise they will put you under general for an emergency C/S without an epidural (you need an hour of IV fluids before they can put in the epidural, then you need to wait for the anesthesiologist), so if they really think you'll end up with a C/S it's probably the better bet to ge tthe epi. But if there's not an additional risk, then I'd say to decline the epi if you are against it - they can't force you to have one, it's completely your choice!

As for tearing, you can try having your husband do perineal massage - I think it's recommended that you start no later than 36 weeks but you can start earlier. I've known a couple people that swear they avoided episiotomy this way. I've had the episiotomy with both (I started tearing with #2 so she just recut) and it wasn't bad. Good luck!

You'll be surprised. I know it doesn't happen with everyone, but most of the people I've ever talked to that had epidurals, including myself, knew when it was time to push. You can feel the pressure of the baby coming, and those are the times you know you need to push. I loved the epidural. I could feel all the sensations, but it didn't hurt, and I was able to walk to the bathroom after they had me all stitched up. For my first, I was able to hold my own legs up, but during the second I did have to have help. Not because I was totally numb, but because the medicine made my legs feel really heavy. The tearing I believe just depends on how fast the baby comes a lot of the time. With my first I had to have the episiotomy, and only had to push 4 times. With my second I had to push maybe 8-10 times and didn't tear or have an episiotomy.

I wouldn't worry about the epidural one bit. I can't imagine you push any differently because you're doing exactly the same job; it's just without pain. I could still feel when it was time to push ... took just a few minutes with our second child and she was out. No clue what purple pushing even means. You can't really move around with an epidural, but honestly, I never felt compelled to get up and move around the room or crouch or anything when I was in labor -- I was just there to finally get the baby out. With an epidural, I felt good and could carry on a normal conversation with family without being in pain. I had an episiotomy with our first and much preferred it over the "natural" tearing I had with our second -- healed really quickly and far less painful during recovery.

My first child was a emergency C-Section and I really wanted to have a V-Bac, natural birth with my next child so my OB and I agreed to let me attempt the VBac as long as I put the IV line in "just in case." So I hired a doula and I was able to give birth naturally and did have that needle in but it wasn't hooked up to anything. That being said, I don't know what your medical issues are but if I didn't havet he c-section with my daughter, she would probably be dead and I could be as well. I know the feeling of wanting a natural birth but in certain circumstances, rare maybe but there anyway, a c-section or a medicated birth are the correct option.
I also did tear w/ my v-bac but it hurt for a few days and then was better.
Good Luck!!
Stephanie

I got my epidural early, 4cm and they had to come back twice because it was wearing off. By the time it came to push my eyes were closed (saying a little prayer cause holy cow this is gonna be hard). When I opened my eyes both my legs were in the air. I had NO feeling. I didn't fell pressure or even the lifting of my legs in the air. It really scared me at first since my doc had told me I'd still be able to feel pressure much like having dental work done...no pain but you still know what's goin on. With absolutely no sensation I still managed to push my little monster out. My OB was very helpful in describing 'how' to push. The best part...my epidural wore off while she was still sewing me back together. Wouldn't have been a big deal but I had a really bad tear. She worked for about 20 minutes. With an epidural other moms told me NOT to ok a little snip because you can't feel how your body is tearing. I can say that's advice I REALLY wish I'd listened to. My down time would have been less had I had a c-section. And just like with a C you just can't put Humpty back together again!

Just a couple points: as Peg said, I've read that recent research shows a natural tear heals better than an epis. Also, look into hypnobirthing (I downloaded just one track of Hypnobabies & it helped me- my 2nd child slipped out in comparison to the first; granted, both were premie, but there was still a noticeable difference!).

Congrats and best wishes for a smooth birth!

The epidural does not have any affect on the actual pushing or whether you will need an episiotomy. The nurse will tell you exactly when you need to push since you won't be able to feel when to push. You can be assisted on getting into suitable positions but I am not sure which are easier or harder once have the epidural. An episiotomy is done to prevent tearing and for the following reasons: if your baby's head is too large for your vaginal opening, if you need a forceps assisted delivery, if your baby is breech presentation or if your baby is in distress, and they are trying to hurry up the delivery. Maybe you can ask if there is a massaging technique to help stretch the perineum - not sure who would do the massaging (doula or nurse). Although, I think if there were such a technique it would be widely known. From what you have mentioned, it sounds like you need to try to keep your thoughts on having a safe birth for you and your baby. Most moms don't get the birth they wanted, but in the end, if the mom & baby are healthy, that's all that matters. I hope everything goes well for you. Get some sleep (as best you can), take care of yourself and enjoy your new journey! Blessings & Peace...

Epidurals do limit the positions you can be in. I received a "walking epidural" and was able to feel my legs the entire time. I let the epidural wear down (as opposed to upping the dosage as it wore off) so that by the time I pushed I could feel everything. It hurt but I was willing to do whatever I had to for them not to have to use forceps or a vacuum on my daughter. I was able to do all of the pushing myself (all 2.5 hours!!) and the nurses all said I did very well for it being my first baby. For me this plan worked great and I felt and still feel good about it. Oh, and the epidural did not extend my labor or the duration of the delivery at all. Good luck! I know it's a tough decision.

With my epidural, I was monitored and the monitor showed when the next contraction was coming. I pushed with the contractions and it only took 1.5 hours of pushing till my son was born. It took 34.5 hrs to fully dilate, but the pushing went just fine. I was in labor 16 hrs before I got the epidural and I was so ready for it by then.

I had 2 kids and 2 epidurals.. and I think epidurals are the best...labor hurts.. really hurts.. like nothing I have ever felt..

the nice anesthesiaologst comes in.. does the epidural and the pain goes away.. ahh wonderful.. I was able to push both kids out..

I was super numb with the first.. but she was in trouble nad her head was sideways and they had to use forecepts.. so I needed to be numb.. forecepts are huge..

So dont be so sure that you dont want the epidural.. I wouldnt necessarily wait till 7 centimeters either... get teh epidural when the pain gets bad.

I also planned on having a intervention free birth... actually I planned on having a home birth. I had my blood tested 1 week prior to giving birth to find out my platelet level was 70! It needs to be over 100 to have a home birth... I went to my acupuncturist in tears. She said it would not be a problem and put me on some herbs and peformed acupuncture. Within 3 days my platelet level was up to 92 and at day 6, when I had my blood rechecked, it was at 136! There is nothing the medical field was able to do and nothing my midwives could do to help me so I was amazed at how effective this treatment was... My acupuncturists name is Dong-Phuong Nguyen in San Diego and she has been a miracle worker with pregnant women. Keep the faith!

I'd like to one what the problem is that could make you bleed so much that he's willing to cut you open so easily. If you have a clotting disorder its one thing. If you have low platelets there are things you can do to up it. If you increase your blood iron levels you will be likely to increase your platelet levels as well. This will prevent bleeding heavily.
While epidurals are known for their pain relief they do have some serious side effects. Some people will tell you "there's no medal for natural childbirth". I hate that. As if we're setting out for some award for dealing with pain! No that's not the reason for avoiding interventions. Side effects and raising the possibility of other major interventions (surgical) and not having the amazing natural childbirth experience: those are the top reasons for avoiding drugs in labor.
In my experience tearing is much easier than episiotomy. I've had both. Episiotomy is simply easier for the doctor to repair. If you don't allow the cut there's always the possibility that you'll end up with an intact perineum. I'd go with that.
If you do decide to allow the doc to tell you what to do (and you can say no to anything regardless of recommendations that may be biased by his desires), epidurals can be given at differing levels of numbness. Some have you totally numb. Some allow you to walk. With a doula there you may be able to get in different positions on the bed (most hospitals will restrict you to the bed with an epidural) so technically you're "on the bed". You can even push in a hands and knees position if you're able to get into it.
If you simply have low iron I would say increase your iron in foods, avoid calcium rich foods with your iron rich foods because the calcium inhibits irons absorption, and have your blood reevaluated before you deliver.
Get a new doctor or midwife if this one isn't willing to work with you (reasonably).
And get a doula.

Echoing what Doula G said. You can get an "epidural" where they put in the equipment WITHOUT having to have the drugs - similar to a heplock IV. If your doc feels that it is worth it to have the access regardless of circumstances, I would say get it put in as early as possible in the labor because as the contractions progress it will be more uncomfortable for you to "assume the position" for insertion. However, like Doula G said, even without that, emergency c-sections can be done without an epidural in place. However, this is that chance that you take. I had a friend that had to have an emergency c-section, anesthesiologist was *unavailable* at that moment and they had to give her a local anesthetic to perform the surgery. This was at a BIG hospital. That's pretty extreme but I worked as a nurse in a NICU and had at least one baby (another case) who died because the surgeon had to wait for an anesthesiologist to get there. If it was my choice between having a heplocked access and possibly risk another outcome because my anesthesiologist had to take a bathroom break, I'd just take the access.
Also, just from Doula G's responses, I think it might be worthwhile to get a doula. I delievered my first son at a little military hospital on a remote island. They had no female OB nurses working the day I delivered and the outcome was not what I had hoped. A doula may have helped manage symptoms better to provide a more controlled environment. Just make sure your doula and your MD are working from the same page. You may want to ask your OB if s/he has had any good experiences with a particular doula(s) and start your search with someone who already compliments the team you have on board. Seriously, there's nothing like feeling you have to play the mediator between the two when you're feeling like you're being tied in a knot already.
Hope this helps!
:-)
jen

I got an epidural when I was about 9cm. It was a small dose and I was able to feel when I had to push. I pushed for 10 mins and my son was out. I tore a little bit and healed quickly without any problems. I was hoping to go without but it got to be to much for me. But I'd do it all over again. Good luck!

Updated

I got an epidural when I was about 9cm. It was a small dose and I was able to feel when I had to push. I pushed for 10 mins and my son was out. I tore a little bit and healed quickly without any problems. I was hoping to go without but it got to be to much for me. But I'd do it all over again. Good luck!

I have only one additional note to add to what the other posters have already contributed. Some recent research, as summarized on http://www.2womenshealth.com/Childbirth/Episiotomy-And-Va..., shows that a tear may hurt less than an episiotomy and heal faster. It would be worth discussing with your OB before the birth. Either way, the healing experience varies a great deal from one woman to the next. I wish you the best with your delivery!

Unless there are different types, an epidural doesn't "paralyze" you. You can get around, walk, push, etc. Good luck.

A couple of things...I read the "pushing" posts, so I'm not going to add on.

1. It depends on the epidural. I had one where I could feel no pain, but all pressure, and could move my legs great. I had another where I was totally "dead" and had NO idea on how to push since I couldn't feel anything. That time the nurse and doctor would said, try this, or try that again. They let me know what I was doing was "productive" to get the baby out.

2. I wouldn't worry about an episiotomy. It's no big deal. I think a lot of if you need one or not depends on your anatomy (ability to stretch), how big the baby is and how long it takes for your to "labor down" and gently open up your body to slowly stretch, making room for the head and shoulders to pass. If you have an epidural, you won't feel anything and afterwards there's so much healing going on, I don't think you really notice it either. EVERYTHING is a little sore and tender anyway, so the stitches don't really matter one way or another.

3. Don't "wait" to get an epidural if you're in pain. There's no medalling for medication free birthing. If you are really uncomfortable or in pain, just get it. Don't wait for 7 cms out of principle. And if you never need it, great!

Wishing you a lightening fast, safe delivery with minimal bleeding issues!

I had my first son w/ an epidural. I had front & back labor and when they gave me the epidural I felt nothing....that was awesome. I started pushing at 7 and had him 19 min later. That was w/ no lamaz and feeling nothing...i just PUSHED:) My second son, I had no epidural. It hurt like hell. After doing both...i would do the epidural any day of the week!!!

I think doula's are wonderful, as long as you do your research and like the person you choose. Your spouse needs to be comfortable with the person too. As for the episiotomy, talk to the doctor and ask that it not be done. My friend's first ob did an episiotomy and cut so deep he damaged the nerves there. She was weeks recovering. I didnt' have one and was healed up much faster. It was recommended to me that I keep a close eye on my nutrition to help with the skin elasticity. The better your nutrition, the less you tear.
Good luck!
R.

I'm not sure what "purple pushing" is, but with my epidural, I could still feel pressure when it was time to push and had no trouble with pushing her out. I did tear, but it seems like the women in my family always do, and it wasnt very bad. I got my epidural at 4 cm and I loved it.

I had an epidural with my two sons and both didn't impede me pushing at all. My husband and the nurse both held onto my legs, which was my preferred way to push anyway. It was like doing giant stomach crunches. I closed my eyes and pushed or looked at the mirror and pushed. Both times, I didn't have an epidural and just ended up with 1-2 stiches, that was it. For me, I highly recommend the epidural. I've done it both ways and you just end up more energetic and able to push because you aren't fighting the pain of the contractions as much. It also didn't slow down my labor at all...which I know is the concern other people have. My boys came out alert and nursing within 20 minutes. In fact, I swear my youngest would have nursed when they first plopped him on my chest if we didn't want to clean him up and warm him up a bit first!

Good luck! And don't be afraid of epidurals. They are modern science trying to make our lives easier!

-M

Is there a medical reason your doctor is pushing an epidural? I am sorry, but that right there would make me uncomfortable unless there was some reasoning behind it. This is your birth to do the way you want-yes, emergencies happen but many MANY births occur naturally w/o the need for emergency c-sections. If there is no medical reason I would refuse the epidural on the grounds that it is not medically necessary and only a convenience for the doctor in case of emergency, there are procedures they can follow in the event of an emergency, that is why they are called 'emergency' c-sections, because they are not planned.

BUT, to answer your question, I had an epidural with two of my four births and was still able to feel the pressure and know when to bear down, your husband can 'stretch' you prior to the birth to avoid tearing, I don't remember exactly how it is done but I learned of it in 'what to expect when you're expecting'. Good luck to you with your new baby!

To answer your question

I'm not sure if it's possible, but if you still want to try for an intervention-free birth, you might be able to compromise and get a hep lock (in case they need to do a c-section), but not get an epidural. Again, not sure if that is possible, but it is worth asking about. I'm a bleeder myself, but I've only ever needed a shot of pitocin after the baby was born to stop post-delivery hemorrhaging. I was still able to have a drug/ intervention-free delivery. I'm not sure what your situation is, but I had miscarried and bled a lot, so I was aware of the potential when I had my son. Your situation might be very different, but it's worth talking to your doctor about.

Good luck to you, and congratulations!
T.

I had an epidural & was able to push VERY WELL! I was surprised at how much I could "feel" even though it wasn't really painful. I had them raise the bed so my upper body was sitting up as far as I could. Then I used my arms to pull my legs toward me (kind of like you're taking a peek at your own crotch). Then I was able to push my son out in about 7 min! Wow! I know every pregnancy & labor is different so I probably just lucked out. But, to describe the feeling in my legs....they were numb like when you get Novocain in your mouth for dental work. You can feel your hand touching your face, but it's not painful. Kind of like that. I didn't have an episiotomy either. I did have some 2nd degree tearing, but is wasn't anything too bad. I made sure the Dr knew I absolutely didn't want to be cut & she assured me that they don't cut you unless absolutely necessary.

It's great that your educating yourself & know your options. It makes YOU in charge more.

Good luck!

Wow Shalimar, not so sure the reasoning your doctor is giving you are that valid but as a D., here is what I would suggest: You could get an epidural site ( i.e. they will put the catheter in but would not pump you with drugs, yet they have an immediate access to it in case of emergency. Some of my clients who deliver twins with paranoid doctors do this, early on so it is not uncomfortable to sit still, but they can still move around and do what they need to do to manage the contractions. Also they can squat to push their baby and almost all never needed to use the actual drug. So it is a good compromise. But remember it is your body so docs can make a suggestion it is up to you to say yes or no. BTW if a woman without an epidural was to have an emergency c-section they would be able to get to her in plenty of time.....

But if you get an epidural ask for a 'walking one" not that they will let you wank but it is a milder one and you will be able to feel your legs. Then get familiar with your hospital bed and ask for a squat bar as you come in, so you can figure out how to use it and yes you can squat even if you have an epidural if it is the one that allows to feel your legs. Most hospital beds are divided into three sections, with the buttons at its side you can actually create a large throne for yourself and holding on to the squat bar, you can squat. Of course it would be great if you could get a D. to show you this and help you along. Go to DASCdoulas.org or DONA.come and see if you can get a D. in your area one you can afford. More info on this and more at joyinbirthing.com
Trust you can do it.