Those who had epidurals - what position did you push in?

[Thandeka]

Debating a VB after horrifically traumatic birth last time. Currently down to have an ELCS due to mental trauma and PTSD.

Am exploring VB options but a non-negotiable for me is epidural but being on all fours or squatting to push (with DH/Doula supporting me. I am absolutely not being on my back with feet in stirrups trying to push a 9.5lb baby up a hill resulting in an oxygen starved possibly brain damaged baby and forceps episiotomy for me again! But I also know I absolutely will not manage without an epidural.

So ladies who managed to not be on their backs at the pushing stage?

(I know it's because of inconvienience of access for midwifes plus worries about if you fall off the bed due to not feeling you legs and sue them but I reckon that isn't a good enough reason!- fwiw I had a mobile epi with DD I believe but was imobilised and topped up too much (again I wouldn't let them do this) and when I was failing to get her out they did offer me to change positions but too late by then as I was exhausted and couldn't move)

I had on my birth plan I wanted the midwife to help me with the best positions so I tried lots, including on my knees facing over the back of bed IYKWIM. She also moved the bed in all sorts of positions, one felt like I was sitting on a throne! So they will help if you get a nice mw!

That said, DD was deep transverse arrest and I had an awful Keillands delivery in theatre.

I know lots of people who think the epidural or lying on their back was the "one thing that made it all go wrong" but I'm sure that I'd never have got her to move to the right position and pushed her out (8lb 9oz, head 91st centile, I'm 5'2" size 8) whatever the circumstances.

I'm 6+3 and burying my head in the sand about birth at the moment but have always said ELCS only for any future babies - I've read your story before Thandeka and I'm curious to know why you're not embracing the cs with open arms? Have you had reassurances about doing it for the second time?

Was on my back. Son became distressed, and ventouse was used to get him out. I was induced and told it wouldn't be possible to get up as I was hooked upto a monitor. I wanted a drug free homebirth!

As a midwife I have no qualms about delivering someone in the all fours position, in fact a lot of the women that I look after naturally choose that to deliver in. However I would feel concerned about a woman with an epidural delivering in the all fours position, I would be concerned about her falling off the bed, not because she might sue me (I don't see what grounds she would have) but because it might cause pain to her and be dangerous to her and her baby. My main worry however would be that she would not be able to support herself and might fall back on to the baby as it were delivering. Having said this most hospitals now have great beds that have bits you can pull out to hold on to and lean on, the bottom part of the bed can go downwards so that you can almost squat on the bed. I feel that this would be safer as if you can't support your legs you can just sit back and in between contractions you could rest in the sitting back postion. I only work in one unit and it is possible that in another area the epidurals are done differently and it would be safer, I used to work somewhere where epidurals were 'mobile'. For most women they could still stand after one or two top ups but after that they didn't have enough leg strength so I do feel that the word mobile is a bit misleading. If you have an epidural you are more likely to need a forceps delivery although I really really don't believe that lying on your back would contribute to a brain damaged baby unless you were lying totally flat. Being upright does help in things being generally a bit quicker and easier but for some women the baby is just not going to come out easily however upright the woman is. When I see posts stating that someone would have had a normal delivery if she had had more support in standing up, and being upright I do feel frustrated that the woman didn't feel she had more support to do her wishes but in many cases it probably wouldn't make that much difference. I have had women that I have had standing up, squatting, all fours walking round for ages and they have still needed assissted deliveries and equally women lying flat or semi recumbent who have pushed babies out easily. I hope you have a wonderful birth no matter what position you deliver in or what pain relief you have.

Hiya - I used a birthing stool which is a bit like a horseshoe shaped plastic seat! You can take the weight off your legs and still be in an upright position, basically a squatting position but your legs aren't taking the weight. It was great because my DH sat on the edge of the bed behind me so I could rest on him between pushes and squeeze his hands whilst pushing! The nurses were sat on the floor in front of me helping me along.

As maxbear said the beds are pretty great these days and for my last DC they basically raised the back to a sitting position and then dropped the end right down so I was sitting up but supported. They worked with sheets/pillows to support my legs. Again DH supported me from behind and the midwives could see the business end!

Hope that helps! FWIW I always asked the docs to make sure they stopped topping me up towards the end of my contractions so I could feel what was going on. Although I regretted that when the crowning started!

Hope things go well!

I pushed on all-fours once finally dilated - took two birthing partners and a MW to get me turned over for it (SPD), and a pile of pillows under my chest.

Not that the pushing seemed to do anything, admittedly, and when meconium was noticed a couple hours later we planned for a cs - though luckily a ventouse got him to suddenly pop out in theatre!

Another lady posted on here that her consultant said women who had ;longer/more complicated/ tricky position labours were more likely to need an epidural anyway but it wasn't nec the epidural necessitating the intervention. Even if thats not true thats what i am adopting as truth as it makes me feel better. :)

Maxbear- will you be my midwife. :) When I finally wasnt left on my own screaming in agony my midwife was pretty unsmiling grumpy and useless and more interested in filling in paperwork than anything else.

Herethereandeverywhere- I must be completely mad but I think personally for me having a successful vaginal birth will be a more healing experience than an ELCS but the caveat is another traumatic experience will result in a complete mental breakdown that I am not sure I would ever recover from. So not sure about taking the risk. Starting CBT in a few weeks and have a few months to decide (having a growth scan at 34weeks- if another porker not a cat in hells chance am trying vaginally)

I had an induction and epidural and laboured on my back. All went well until the final stage where forceps were needed. I was told this was because ds1 had his hand on his face and his shoulder abducted so he didn't make an appearance after an hour of pushing. So as far as I am aware it wasn't a result of the epidural

Can you ask for an anaesthetic referral (our local hospital runs an antenatal clinic with consultant anaesthetists). This would be the ideal opportunity to discuss the epidural used in your hospital (there can be a lot of variation) and therefore what options will be possible. This could then be written into your notes - ie Thandeka would like to be upright etc so could anaesthetist do x, z, z etc so that whoever is on duty when you are in labour is aware of your plan.

That said I have only seen pushing in semi rec, assisted sitting or lying left lateral (with leg supported - this works very well)

Good luck

There is an epidural session you can book onto so plan on going to that and trying to get answers there.

Also got a lot more meeting midwifes and more reassurances etc before I go down this route (is a new hospital to last time seems better but not convinced they can support me sufficiently to stop nervous breakdown in or after labour so maybe i should just take them up on the ELCS offer. :)

On my knees facing the back of the bed. It was great. Pushed for two minutes and baby was out.

On my back.

Ended up in lithotomy complete with stirrups, and then forceps.

I had an epidural with DS2. I was on my back, but sitting high up against a pillow and no stirrups or anything - think I was holding my thighs.

It was MILES easier than my first labour (no epidural) where they tried on all fours, but eventually giving birth on a birthing stool. I ended up with a 3rd degree tear because of the pressure.

Thandeka I would love to be your midwife I delivered a woman who was very distressed and upset about her previous birth experience on my first shift back after maternity leave, she sat in the birth pool immediately after giving birth and said 'I did it' with a huge fantastic smile on her face. It was a very satisfying experience for me, that I felt I had been able to facilitate a good experience for her that was a healing experience and this sort of thing is one of the most satisfying parts of the job for me. I would encourage you to go for a natural birth as it may well be the healing experience that you need. Maybe try and talk to a supervisor of midwives about it first so that you can formulate a birth plan with her to ensure that even if you need a hand at the end you still have a positive birth experience.

On my knees facing (and leaning on) the head of the bed. After 2 hours of pushing DD became distressed and they got me to lie on my back, the mw performed an episiotomy and I managed to push her out while the doctor was preparing the ventouse. Best of luck, I'm almost 29 weeks with DC2 and scared witless!

On my back,,, having very weak contractions ( hurt anyway) had something to make them stronger, and then had an episiotomy and pushed him v quickly after that.

Pushed for an hour and a half on my back, the midwife tried to get me to put my feet in stirrups but I found it really uncomfortable so only tried that for one or two pushes. In the end she said I would have to find a different position as DS wasn't going to arrive like that, so I was on my left side with DH supporting leg and DS popped out fairly soon after that :) I did have a second degree tear, but no way of knowing if this was the position or not.

Sitting up in bed, BUT with each push I pushed down really hard with my hands and raised my bottom off the bed to 'free up' my pelvis so it wasn't squashed so much. Very smooth delivery. Personally I find the idea of all fours anathema. I want to grab the baby and cuddle it to my chest straight away, so I prefer this way. Have had 4dc all in same position.

I had my two older DSs on my back, but just with gas and air. Then I had an epidural with my youngest (his head circumference was 38cm even though he was a month early ). But the epidural was amazing - I delivered kneeling on the bed and holding the bed head (I was determined not to be on my back for a third time!). I only asked for it quite late on, and they gave the perfect amount so I could feel when to push but had no pain. Amazing, and a lovely calm delivery, so the epidural doesn't have to mean a cascade of inerventions stuck on your back... Good luck!

I've not give birth yet, but the MBC in Stoke have cushioned mats if you want to be on the floor rather than the bed. Maybe you could ask if they could offer that? That takes away any risk of falling off

I had epidurals with both DCs and pushed lying on my left side with both. Worked great with both - came out after 3 pushes (20 mins for 1st and 15 mins for 2nd). Found it much easier to push effectively than on back. Mine were mobile epidurals.

Oh and tiny tear for DC1 and no tears with DC2.

I was told by the midwife I had to lie on my back because I had an epidural but I had talked about this with an obstetric anaesthetist I knew socially and he warned me not to be on my back. I gave birth very easily and totally without pain, sitting on my heels bolt upright - you have the force of a gravity acting the right way and it helps. You also are first to see the baby which is magic! I did not allow the epidural to be tailed off (that is not recommended - it causes terrific pain and does not reduce instrumental deliveries). There is now a big research trial called the BUMPS trial which is investigating this - not before time because upright positions and the impact on reducing instrumental deliveries has been known about for years.

I am at a loss to understand why, when epidurals make labour so much easier, some midwives try to deter women from having them because of the so called cascade of intervention. If this is such a big issue, why does France have twice the epidural rate of UK and lower instrumentals? Also, why have midwives not initiated research into reducing instrumental deliveries by encouraging women to be upright? What's the motivation? I don't understand it.

According to my consultant, cascade of intervention is a myth (if one looks at the scientific evidence - how many midwives actually quote scientific studies and stats?). However, administering epidurals is costlier (requires anaesthetist, drugs, etc.) so I would not be surprised if some hospitals try to discourage them to save costs for the NHS or because of lack of resources.

Had a lovely easy vbac with a epidural in place, although the epidural wasn't topped up from 8cm on because of fears of scar rupture. Delivered semi on my back, sort of sitting up. No problems with pushing, and dd2 had a head off the scale. Good luck in what you decide to do, although I wouldn't blame you if you went for elcs taking into account your past experiences.

Strangly when I had an epidural with dc1 I gave birth on all fours (supported by the headboard) with my next two I had no drugs and gave birth on my back both times - I agree that it is not always the epidural that causes the problems but the fact that the labour is long and compicated already (and that is what leads to an epidural being needed!)
Whatever happens I wish you luck - my 2nd labour was so much easier than the first.