You've put careful thought and consideration into your birth plan, and have decided with your provider that a planned epidural is right for you. But if it does its job and you're not feeling anything down under, you have to wonder, how will you actually know how to push during labor with an epidural?
According to Orange County OB-GYN Dr. Thomas Ruiz, many practitioners actually turn down the epidural when it's time for the pushing phase, in order to help the mother listen and respond to her body's cues. Ruiz tells Romper, "The epidural is typically placed by the anesthesiologist once a woman enters the active phase of labor. When a woman gets to the pushing phase, the epidural is often turned off or turned down to allow the woman to feel the pressure of the fetal head against the perineum, creating a sense to push. Turn down the epidural too soon, the pain of contractions can inhibit pushing in some women." He notes that one technique used to maximize the pain relief provided by an epidural is to wait until the woman is crowning before lowering the epidural. "Once the perineum is being stretched, the woman can feel the urge to push," he says.
Ruiz points out that a uterine contraction monitor can also indicate to mom when it's time to push. Pushing with an epidural, he notes, is easier for women who have already given birth before and know how it feels than it is for first-time moms.
But Childbirth Educator Robin Elise Weiss says there's no reason for a first-time mom to feel unprepared, and childbirth classes should cover this crucial part of birth. In an interview with Romper, Weiss says a mom can "place her hands on her abdomen and feel her contractions with her hands, be directed to push by personnel watching the fetal monitor, or have an epidural that allows her to have a sensation to push without pain."
How long can you expect the pushing stage to last? There are no guarantees, Weiss says. "It typically takes the first-time mother a little bit of time to get the hang of pushing. Some babies seem to come down and out very quickly, while others take a lot of hard work and sweat." With a little luck, your bundle of joy may be out in three pushes. But you might want to start prepping your body now, just in case they decide to make it a marathon.