You still have options even with an epidural! You can labor in a number of positions and even push in tons of positions other than just on your back.
We may think that because we have an epidural we are limited to only a supine or lithotomy pushing position, but this is not true!
But, if you do want to push on your back, let’s break down a few tips to make it an effective position for you, as well!
Read this blog to learn six epidural pushing positions!
Pushing with an Epidural
When pushing with an epidural, there are variations in how much sensation you may feel and how much movement capability you have, depending on the strength of your epidural.
If you have the ability to move, move! You can flip onto all fours or even move into a supported squat position!
If you need tons of physical assistance to move into a position, then it may not be safe for you, and we may want to focus more on positions that are supported by the bed, such as supine or side-lying.
Learn more pushing techniques, such as breathing techniques and how to approach pushing both unmedicated and with an epidural, in our pushing webinar!
We break down how to approach pushing in all our childbirth education courses and in a mini-course if you want to focus only on pushing!
Alicia
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I took the MamasteFit pushing course to prepare for the birth of my second baby after my first baby was over 11lbs, I pushed for over an hour and on my back, she had shoulder dystoica, aspirated meconium, needed resuscitation and went straight to the NICU for a week. I broke my tailbone and burst ALL of the blood vessels in my eyes. I desperately wanted my second birth to look and feel different and better! Using the techniques I learned in this course, I was able to manage contractions really well and pushing was... dare I say "easy"?! I waited for that fetal ejection reflex to kick in and BOY DID IT! I accidentally had a home birth because my baby was born after just over a 2 hour labor- but it was amazing and healing and so redemptive. I also just had my 3rd baby a week ago in a planned home birth and had another amazingly smooth and short labor. About 12 minutes of pushing and no tearing for a 10lb 7oz baby girl! Thank you MamasteFit for such great pushing info!
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Use the Bed!
When pushing with an epidural, we usually need to be in the bed. Good news is that the labor bed can be adjusted into so many different positions to support your pushing position.
If you feel unsure how to adjust the bed, ask your nurse to show you how or ask for their recommendations!
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See AlsoDoula Demographics and Statistics [2024]: Number Of Doulas In The USEffect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysisPostpartum Doula vs Night Nanny/Nurse: Choosing the Right Support after Childbirth - CLEBaby Doulas and Childbirth Classes
1) Supine: Create Space for the Sacrum
The most common pushing position with an epidural is to push on your back or supine/lithotomy.
But, we need to ensure that we still create space for the sacrum to move freely, or else we may find pushing takes a lot longer.
Fortunately, if you find pushing on your back is most comfortable, we can use props to create some space!
We can add a pillow along the torso to tilt us slightly or use two pillows to make a railroad track for us to be propped up. The labor bed also has a cutout portion that may help create space!
2) Sidelying
The next most supportive, and usually accessible position with an epidural, is sidelying!
In sidelying you are rolling to one side to push. This position seems to have the lowest risk of tearing, mostly due to your legs tend to be closer together and more relaxed!
It’s also nice because you only need one person to help support your leg, which makes it easier to maintain internal rotation while pushing!
3) Throne
Supine and side-lying are more reclined positions, so let’s explore a few upright positions that you can achieve with an epidural!
The first is throne! We need to adjust the bed into a chair-like position, and then I like to set up the squat bar attachment so you can hold onto something.
With all upright positions, it is important that you can move into the position with fairly little assistance, otherwise, it may not be a safe position for you.
Throne is usually easy to get into, but may not be a great position to deliver in. But can be a helpful position to do during the earlier part of pushing to help move baby down!
Childbirth Education Course
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We break down pushing positions for the epidural, plus labor positions for the epidural in our childbirth education course!
Sarah
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I was really nervous about giving birth, especially during the Covid 19 pandemic. I wanted to have as little intervention as possible during my pregnancy and birth, but I wanted my husband and I to feel empowered to make decisions regarding interventions or procedures if we needed to. Finding an in person birth class during the pandemic wasn’t possible, and I am so glad we found MamasteFit. Not only did I follow them for great advice regarding general exercise and pain-relief recommendations during pregnancy, but their labor and delivery course + supplemental webinars were fantastic. The ladies provided unbiased and evidence-based information in digestible pieces so that we could pace ourselves while we learned and feel competent in understanding a pretty complicated process (birth is amazing but can be so intimidating.) I will repeat the course for baby #2! I am always learning something new when I follow along on Instagram, and I recommend the course to everyone. We had a wonderful birth experience and are ready to do it again!
Sophie
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My birth was an unplanned cesarean under general anaesthesia. It could have been frantic and deeply traumatic, but thanks to the childbirth education course I had prepared myself and my birth partners for this possibility. My partner even remembered from my birth map that I wanted a vagin*l swab applied to the baby in the event of a c-section - in the moment I had forgotten! But thanks to the calm and comprehensive education we received from this course we were able to navigate the challenges that arose without feeling overwhelmed.
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4) All Fours/Kneeling on Bed
Another upright position is all fours or kneeling on the bed! You can use a stability ball or peanut ball to support your chest, or incline the head of the bed to lean on as you push.
Again, for upright positions, you need to be able to get into the position with little assistance, otherwise, it may not be a safe position for you.
5) Squat with Support
Setting the bed up in a similar setup as the throne, we can also do a squat position!
When doing squats, ideally, we do one that is more hinge-like (butt to wall behind us) than squat-like (butt to floor), but with an epidural and being restricted to the bed, the squat may look more like a squat as opposed to a hinge.
When doing a squat, we still want to focus on trying to find more internal rotation, so think knees in, ankles out.
I would not recommend delivering in this deep squat position, as it can increase the risk of tearing, but can be a helpful position to move baby down.
6) Add a Tug of War!
And finally, we can add some power to our pushes with a tug of war!
With the tug of war, you are pulling on a long fabric between the legs or above to help engage the lats to add power to your push.
Watch the reel for some examples!
You are not limited to only pushing on your back!
Even with an epidural, we can still make decisions about our birth! You can push in several positions and use props to support your pushing.
Try to maneuver the bed in different configurations and shift around to find the most comfortable position!
