Labor Positions with an Epidural: There’s More Than You Think!

Last Updated: June 17, 2024
Liesel Teen, RN-BSN

By Liesel Teen

BSN, RN, Practicing Labor and Delivery Nurse

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It doesn’t take labor and delivery experience – whether as a patient or a professional – to know what an epidural is. 

I would venture to say that if you are over the age of 18 maybe (younger for some), then you are familiar with epidurals and their use during birth.

One thing that a lot of people don’t know however – is that there are quite a few labor positions with an epidural that you can utilize during your birth.

Yep, it’s true! Gone are the days of pushing only on your back, mama.

Have I piqued your interest? Read on to learn more about different labor positions with an epidural.

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What is an epidural?

Now, I know I said there’s a very good chance you are familiar with an epidural. And if you have found yourself on my website and reading this blog article then I feel very certain you know what an epidural is. 

I’m not someone that likes to assume anything, because you know what that does (makes an ass out of u and me – did I just take you wayyy back??), so I’m going to take you back to the basics.

If you have taken my Birth It Up: The Epidural Series course then this should definitely be a review, so bear with me. 

Simply put, an epidural is an injection administered in your epidural space of your back to eliminate pain.

Epidurals are often referred to as the “gold standard” when it comes to pain management during labor and birth because of their magical ability to eliminate all or most of the pain associated with birth (for most!).

Typically, an epidural is placed by an anesthesiologist, CRNA (certified registered nurse anesthetist), or another member of the anesthesia team.

Some obstetricians actually used to be trained in placing them also but from my personal experience, it seems that’s not the case any longer. 

While it is considered to be the “gold standard” of pain relief when it comes to labor, it’s not the only form of pain relief for labor. If you want to learn more about pain relief options other than epidurals, be sure to read my article below.

Related Reading: A List of Pain Meds During Labor Other Than Epidurals

What will it be like when I have an epidural?

Much like a lot of medications, an epidural can have a slightly different impact on different people. Even on the same person, an epidural might work better for one labor and not as well the next time, or vice versa. 

An epidural placement is something that we, in the labor and delivery world, consider to be a “blind procedure”. Now before you get all panicked thinking that the provider placing it is wearing a blindfold or something, let me explain. 

Your epidural space is not something that is visible (it would be cool if we could see through your skin for certain procedures), so the provider must feel around your back to find the best placement location.

The anesthesia providers are typically very, very good at doing this, but there are some circumstances, usually out of their control, that can make placement easier or more challenging.

Related Reading: An L&D Nurse Explains: Epidural Catheters, Epidural Placement, Epidural Needle Size, and More! 

How I explain it to my patients

I haven’t personally experienced an epidural, but I’ve taken care of my fair share of epidural mamas at work. Here is what I tell my patients about what it should feel like with a properly working epidural. 

An epidural is meant to take away the sharp pain most women feel with contractions. What an epidural is not meant to do is to take away the vaginal and rectal pressure that you likely will feel as baby gets lower into your pelvis and close to delivery. 

I won’t sit here and say all women with an epidural feel pressure or guarantee you won’t feel anything because I’ve seen it go every which way. 

Why it’s good to feel pressure with your epidural

The thing is, we actually want you to feel pressure as you get close to delivering. Pressure helps guide your pushing, and helps you know when to push and how to push. I’ve seen it many times, a mama that is so dang numb from her epidural that she literally cannot push. 

No this doesn’t mean you will automatically end up in a C-section, but it can absolutely make for a longer, more challenging, and more exhausting pushing phase. 

Think about what your body is trying to do – push a whole entire little human out of your hoo-ha. It would be a tad weird if you didn’t feel anything at all, right?

Embrace the pressure, use it to your advantage, and look at it as a way to help you get your little one out sooner. 

After all, it’s all about perspective at the end of the day, right?

Can I do different birth positions with an epidural?

You absolutely can utilize different birth positions with an epidural in place! If anyone, this includes your delivery team, tries to tell you otherwise, I encourage you to speak up for yourself!

Somewhere along the way epidural women were instructed that the only position they could push their baby out in was on the back.

I am here to tell you that this is false and provide you with accurate information. Different labor positions with an epidural should be an option for you, mama!

Why positional changes during labor with an epidural are important

The benefits of positional changes during labor are plentiful. The first benefit is pain management.

Believe me, mama, as someone that experienced two unmedicated labors (by choice), position changes during labor are crucial for pain management!

Another benefit to position changes during labor is helping with labor progression – and this is true with OR without an epidural!!

Frequent maternal movement during labor can help baby into a more optimal position for birth and allow for quicker dilation.

Frequent movement also allows the baby’s head to put more pressure on your cervix, which in turn also helps with dilation. 

So, utilize those different labor positions, especially with an epidural.

Birth Plan

Labor positions with an epidural

As I mentioned above, pushing on your back is not the only way you deliver your baby with an epidural in place. 

Below I will address some of my favorite labor positions with an epidural, and the ones that are most commonly used in practice.

1. On your back

This is sort of the classic position that we often think of when pushing a baby out. Honestly, there’s not a problem with it, I actually preferred pushing on my back during one of my births!

But it’s not the only way to push. Maybe give it a shot before you knock it, but definitely try some of the others if it doesn’t seem to be working for you.

2. Side-lying

Side-lying is known as a more “restful” position. Let’s be honest, there are few comfortable positions for a pregnant lady to be in.

I don’t know if you agree with me, but side-lying was definitely one of the more comfortable positions for me during pregnancy.

You can also use lots of pillows or the peanut ball between your legs for extra support so it’s a win-win! I LOVE to use this position with my epidural mamas.

3. Hands and knees

I love this one! This is a very popular position where I work. It does sort of depend on how dense your epidural is, but I have gotten plenty of epidural mamas up on hands and knees (usually with some assistance).

You might not be able to tolerate it for a super long time with epidural legs, but it can definitely be an option for some.

Fun fact, it’s also a great position to help baby rotate if we think they are in an occiput posterior (OP), or sunny side up, position.

4. Semi-seated

This one takes a little maneuvering of the bed. To do a semi-seated position, your nurse will raise the head of the bed or use pillows to support your back.

Then we will drop the feet of the bed, labor beds are magical you guys. We can even attach the birthing bar to the bottom of your bed for added support.

Again, this one sort of depends on how heavy your legs are, but lots of women love the idea of having gravity on their side.

What is laboring down?

I’m so glad you asked, I love laboring down with my mamas. I talk about it most often with epidural mamas, I’ll explain why, but technically anyone in labor can labor down. So why do I most often use the phrase “laboring down” with epidural mamas? 

Usually, my unmedicated mamas feel such an intense urge to push toward the end of labor that it’s close to impossible for them to resist the urge to push. If you have the ability to resist the urge, even without an epidural, then by all means, give laboring down a shot. 

It’s really dang hard though, trust me, I’ve been there!

What is laboring down?

Laboring down refers to delaying actively pushing for 1-2 hours once you have reached 10 cm dilated. A lot of people think they have to start pushing once they hit 10 cm but this isn’t always true.

While dilation is definitely important, we also take into consideration mom’s station during labor. 

Head station is the third part of the cervical check equation, dilation, effacement, station. We measure station by how far baby’s head is above or below your ischial spine (zero station).

Anything above your ischial spine is referred to as -1, -2, -3 station. 

Anything below your ischial spine is +1, +2, +3. You might be dilated to 10 cm but baby’s head station might still be a tad high. In this case, especially if you aren’t feeling pressure, I, as your nurse, might recommend laboring down!

Advantages of laboring down

There are 2 big advantages to laboring down. Laboring down can help you conserve your energy for pushing and decrease your overall active pushing time.

I personally think laboring down can be hugely beneficial for mamas. Believe me when I say pushing can be exhausting. Anything you can do to make pushing less exhausting and more productive is a win in my book! 

Does an epidural slow down labor?

I get asked this question all the time! The quick answer is yes and no. Epidurals definitely get a bad rap for slowing labor down. While this can be true, it isn’t always true! Most often this is true when someone gets their epidural too early in the labor process. 

Truth be told, you should get your epidural whenever you ask for it. Everyone interprets and copes with pain differently so if you are in labor and in pain and you want an epidural, then you should get it.

As a labor and delivery nurse with almost nine years of experience though I would recommend waiting until you are having painful and consistent contractions and your cervix is changing before you get it. 

It’s totally okay for you to get your epidural early, and a lot of women do, I just want you to be aware of the potential for it slowing down your labor. You might be asking, why is it bad if it slows down my labor and that’s a great question.

The main reason is that it can (not always) start a domino effect, something often referred to as the cascade of interventions. A slowed or stalled labor can lead to a need for augmentation, which can lead to other potential interventions. 

So, to answer whether or not an epidural slows down labor, I would say it has the potential to if received too early in labor, but there is no guarantee.

Related Reading: Important Epidural Side Effects and Facts You May Not Know!

Birth plan epidural

Curious how to put together a birth plan for your birth? You have come to the right place! Let’s first start by discussing what a birth plan is and what it should include.

A birth plan is basically a guide or form that makes your birthing team aware of your preferences surrounding labor, birth, immediate newborn care, and postpartum hospital stay.

A birth plan gives you a chance to think through your preferences and discuss these preferences with your support person and your provider prior to birth. There’s no way to guarantee everything will go according to your plan, in fact, the only guarantee I can make is that things likely will not go exactly according to plan. A birth plan does however allow your labor and delivery team to help you have the best birth possible. 

If you know with 100% certainty that you want or need (sometimes for medical reasons) an epidural for labor, then it’s best to plan and prepare for birth with an epidural.

There are some key things I recommend focusing on when writing a birth plan that includes an epidural. I cover these things, and more, in detail in this article, but let’s briefly review. 

The key components, specific to epidurals, you should consider include:

  • How long you will want to go without an epidural upon admission to your place of delivery?
  • If relevant, how do you plan on coping with the pain until you are able to have your epidural placed?
  • How will you cope with labor pain if your epidural is unsuccessful? 
  • Position changes you wish to utilize 

And to help make things easy for you, I have a totally free birth plan template that you can sign up to receive here.

Wrapping up labor positions with an epidural

So, there you have it mama! We have not only covered labor positions with an epidural but tons of additional information about epidurals, laboring down, birth plans, and more!

This is just one of many epidural resources I have about epidurals and birth. If you find yourself looking for more epidural resources, be sure to take a look below.

And of course, if you want to find all my epidural information (and so much more) in one place, I highly recommend checking out my Birth It Up: The Epidural Series birth course!  

Cheers to an even better birth, mama!

Additional epidural resources:

How Does an Epidural Work? When to Get an Epidural? The Entire Epidural Process Explained! 

Episode 171: Epidurals 101: Get Informed About Epidurals for Birth

Epidural Pros and Cons

How epidurals work reel

Birth Plan
Liesel Teen, RN-BSN

Liesel Teen

BSN, RN, Practicing Labor and Delivery Nurse

As a labor and delivery nurse, I’ve spent countless hours with women who felt anxious — even fearful — about giving birth. I want you to know it doesn’t have to be that way for you!

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