5 Tips for Pelvic Floor Friendly Pushing with an Epidural
Planning on having an epidural, but worried about how it will impact your pelvic floor?
This is a really common concern because generally pushing with an epidural is associated with back-lying pushing. Now, the first thing I want to note is that you don’t have to push on your back with an epidural. There are other super effective pushing positions. If you’re worried about being able to push in other positions, I highly encourage you to speak with your doctor about their standard practice and experience delivering in positions other than back-lying.
Now that we’ve covered that, here are my 5 tips for pushing with an epidural:
Hold Off Until You Have the Urge
Did you know there are actually 2 phases of pushing?
The second stage of labor, AKA the pushing phase, actually has a latent and an active stage.
So if you're 10 cm and you don't feel the urge to push, you're likely in latent second stage and your body may not be ready to push quite yet.
Laboring down for 1-2 hours after reaching 10 cm is a great way to rest and conserve energy for the active pushing phase of labor and can shorten your pushing time, and effort, allowing your body to do it's thang to bring baby down.
Studies also show that laboring down can reduce fetal stress and result in fewer heart rate decelerations.
Bear Down in Efforts of 6-8 Seconds
Coached pushing, when you bear down for a count of 10, and “purple” pushing, when you hold your breath for long periods of time while bearing down, can increase pressure on the pelvic floor.
Bearing down and breathing into your pushes in efforts of 6-8 seconds a few times per contraction can allow the pelvic floor and perineum more time to open and stretch. And the theory is that not forcing that stretching or opening can reduce your risk of more severe tearing.
You can also go with what your body naturally wants to do. It can also be hard to understand or feel HOW to push with an epidural, so if you need some coaching- that’s okay too.
Push in a Different Position
Did you know you actually don’t have to push on your back if you have an epidural?
YUP! Other positions are absolutely possible with an epidural and pushing flat on your back isn’t allowing for gravity to do some of the work for you.
Try pushing in side-lying or upright seated with the bottom of the bed lowered and your feet flat- you can also use a squat bar to help. If you have a supportive team, you can even birth on all 4’s with an epidural!
If you end up on your back, incline the bed so you’re able to use gravity to your advantage.
Try Knees in Feet Out Pushing, Breathe, and Relax
KIFO pushing is a great way to open the pelvic outlet, which can allow for more room for baby to exit! This is a neat little trick you can try in any position rather than bringing knees to chest.
Breath is such a powerful tool when it comes to birth. It can help you better manage contractions AND help reduce pelvic floor trauma. If you don’t remember any of the other tips here, remember to breathe and relax. Relax your shoulders, jaw, glutes, and inner thighs to help your body soften and open.
If You Feel Like You Need to Poop, You’re Doing it Right
I know the thought of pooping during birth is terrifying, but if you poop or feel the need to poop during pushing- you’re in the right spot.
And as someone who has attended births, I can 100% tell you that none of us care or will announce to the whole room that you pooped. It’s our little secret.
Prepare Your Perineum
Doing some prep work before birth- like perineal massage and stretching, stretches that open the hips, and pelvic floor relaxation exercises- can be beneficial when it comes to reducing your chances of more severe tearing.
Here’s a quick video on how to do perineal massage effectively.