Pushing During Labor With an Epidural: Every.Question.Answered.

If you’re thinking about an epidural for your birth, you may be wondering about pushing during labor with an epidural. It’s actually a question that I get a lot!

It makes sense. I mean if you supposedly can’t feel anything, then how will you push?

Well fortunately, it’s still definitely possible – and in this article, you’ll learn all about how to push with an epidural, epidural pushing positions, and even some tricks to help you if pushing isn’t going well.

You ready to learn? Let’s talk about epidurals and pushing!

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What is the pushing stage of labor?

Did you know that there are four stages of labor? If not, don’t feel bad! This wasn’t something I knew about prior to becoming an L&D nurse, so consider yourself off the hook! 

Pushing is actually the second out of the four stages of labor. This stage begins when you hit 10 cm and ends when you deliver your baby – woohoo!

The length of this stage can vary – I’ve seen mamas push their baby out in one, big push (usually not their first baby) and others push for several hours (don’t worry, this isn’t the norm either). 

There are always exceptions to the rules, but pushing normally takes around 2 hours for first-time mamas. 

The four stages of labor include:

  1. Contractions and dilation 
  2. Pushing and birth
  3. Delivering the placenta
  4. The first 1-2 hours postpartum

Interested in learning more about each stage of labor? Check out this article: The Four Stages of Labor

What’s it like to push with an epidural?

If you receive an epidural during labor you can expect to push a bit longer than the typical non-epidural mama – at least that’s what I typically see. 

But remember, there are always exceptions to the rules! And there are definitely some things that you as the laboring mama can do to try and expedite this process.

Simply put, the goal of an epidural is to take contraction pain away. It is normal and expected for an epidural mama to feel vaginal and rectal pressure, especially as she gets closer to the pushing stage and even during pushing.

Why is this you ask? 

Well, it would be pretty tough to push a baby out of your vagina if you couldn’t feel a thing, right?

Most mamas that get an epidural during labor expect to not feel a thing. While this is the case for some, it’s actually not the intention. 

Rectal pressure actually helps guide mamas how to push and when to push and can decrease pushing time and reduce the potential need for an unplanned C-section. Of course, your labor and delivery nurse will be able to coach you during pushing, but trust me – your pushing will be a lot more productive and effective if you are able to feel something

Rest assured, if you are one of those mamas that finds yourself with a super dense epidural in labor, don’t panic that you are going to push for four hours or end up with a C-section – there are lots of positions (even with an epidural!) that you can utilize to help increase the effectiveness of your pushing.

Ready to learn more about pushing positions with an epidural?

When it comes to pushing, there are two very important things that I want you to keep in mind:

  1. Don’t feel as if you must push in a certain position
  2. Do what feels good to you 

I tried pushing on my hands and knees and I hated it! I much preferred pushing on my back, but I know lots of women probably shudder at the thought of giving birth on their back. I tell you this to reiterate the fact that what works for one person doesn’t always work for another. And what works during one birth might not be what works for you the next time. 

As an epidural mama, you won’t have quite as many options when it comes to pushing because you will be confined to your bed but here are some that you might want to try.

4 Epidural pushing positions you need to know

1. Epidural pushing position: On your back

  • The “classic” position we think of when pushing out a baby
  • Some mamas simply prefer to push on their back over other positions (I know I sure did!) 

2. Epidural pushing position: Side lying

  • Known to be a more restful pushing position 
  • Can be used with a peanut ball between your legs or lots of pillows for additional support

3. Epidural pushing position: Hands and knees

  • This is a very popular position where I work
  • A good position to help baby rotate (if we suspect baby is OP/sunny side up) or if baby is having dips in their heart rate
  • Your ability to do this will depend on how dense your epidural is, and you might not be able to tolerate it for super long with epidural legs

4. Epidural pushing position: Semi-seated (with or without a squat bar)

  • The head of the bed should be slightly raised, or you should be supported with pillows
  • Can help you curl around your baby as you push
  • Can also be used in conjunction with a squat bar 

How to push during labor with an epidural?

There might be some minor things that differ when pushing with an epidural, but the overall pushing concepts surrounding pushing apply whether you have an epidural or not. 

Ready for a little pushing crash course? Here we go!

When it comes to pushing, I usually let you do what feels best for you at first, and if it’s working, great, keep it going! If not, I usually guide mamas to push using this method:

  • Grab behind your knees (if you are on your back or side lying)
  • Curl up around your baby (pull your head up off the bed)
  • Take a big deep breath as if you are going under water
  • Hold all your air in and bear down as if you are super constipated and trying to poop 
  • Hold this for 6-10 seconds
  • Relax, take another deep breath in, and repeat for a total of 3-4 times per contraction 
  • If you are pushing in a position other than your back or side, I would essentially direct you in the same way, you just wouldn’t necessarily have to curl up around baby 
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Tricks for more productive pushing positions with an epidural

As a labor and delivery nurse, there are a few tricks we have up our sleeve if it seems that pushing isn’t quite as effective as we want or need it to be.

1. Position changes

Like I just mentioned, there are lots of benefits to changing your position during labor and birth. 

Changing your position can cause baby to move, wiggle, or change their position, which might help them get into a more optimal birthing position and allow for more effective pushing.

This is likely the first thing I will do if you push for a few contractions in one position and have minimal progress.

2. Laboring down

We can use this technique if you are 10 cm dilated, but baby’s head is still high and you aren’t feeling pressure. Let me explain.

Typically, what happens with laboring down is we put you on one of your sides with the peanut ball between your legs. The peanut ball is exactly what it sounds like, a ball shaped like – a giant peanut!

The purpose of the peanut ball is to keep your pelvis open, allowing baby’s head to drop into your pelvis easier. In my opinion, it’s a win-win position. You get to “rest”, baby does some work, and you push for less time!

3. Make pushing a “game”

Maybe game isn’t the right word, but let me just explain what I mean by this. Have you ever heard of someone playing tug of war during labor? It’s a great technique that can be used to add a little power to your pushes!

Here’s how it works:

  • Your nurse will wrap a sheet around a squat bar that’s attached to the end of your bed
  • During a contraction, you “climb” up the sheet, which causes you to bear down similarly to how you would if you were curling around your baby and pushing in the “traditional” way 
  • The same concept can be accomplished by your labor nurse or support person holding one end of a sheet and you holding the other

I’ve seen this work wonders for some women and then I’ve seen others that try it once and hate it. I recommend trying it for a couple of contractions and switching to something else if it doesn’t seem to be working!

4. Perineal pressure

Some women are just so numb from their epidurals that they can’t feel a thing. Remember, the goal of an epidural is to take away contraction pain but not to take away rectal pressure as baby moves lower into your pelvis.

Some women respond well when their nurse or provider puts gentle pressure inside the vagina to help direct pushing efforts.

Their fingers do not need to be in there the entire time – sometimes it just takes one or two pushes to get the hang of it.

5. Turn off your epidural

Okay so this isn’t something that’s done often, but if we have exhausted all other interventions, we can, with the guidance of the anesthesia provider, turn your epidural off.

This might be for the remainder of your labor, or it might just be briefly until you feel enough pressure in your vagina and/or rectum to be able to effectively push!

When we do this, it’s one of our last-ditch efforts to help you push baby out and avoid a C-section.  

Does it hurt to push with an epidural?

That really depends on how dense your epidural is, but you are likely to feel something at some point during the pushing phase whether or not you have an epidural – I mean, you are pushing a big ole baby out of your vagina, after all! 

Are there women that go through the entire pushing stage without feeling an ounce of pain? Absolutely! But is this the norm? Absolutely not! I don’t care what your friend or your sister or your neighbor has told you about their own birth experience, an epidural is not meant to take away 100% of your pain during labor and birth. 

Have I mentioned that enough already? Just want to make sure you have a realistic expectation! 

So? Does it hurt to push with an epidural? 

Maybe it won’t, but more than likely you will experience some degree of discomfort or pain, hopefully only in the way of pressure, while pushing your baby out, even with an epidural.

You can also expect the pressure sensation to become more intense as baby gets closer and closer to coming out – most women describe it feeling like the baby is coming out of their butt. 

If you’ve never heard this before then consider yourself warned. But really, I’m all about setting realistic expectations and am not in any way, shape, or form trying to scare you. The more you know, the more you know, am I right?  

Do you feel the ring of fire with an epidural?

Along the same lines as “does it hurt to push with an epidural” is the question of whether or not you will feel the ring of fire with an epidural. The short answer to this question is it depends

Maybe you will feel the ring of fire when pushing with an epidural and maybe you won’t – there’s no way to predict it ahead of time as each epidural placement is different and unique. 

You might be asking yourself what is the ring of fire? As baby’s head is crowning, you might feel what is commonly referred to as the ring of fire. This happens as a result of the skin around your vagina and perineum stretching to allow for baby to pass through. 

While it is most common for mamas without epidurals, some epidural mamas do report feeling the ring of fire as well. Many report it feeling like a burning or stinging sensation in their vagina. Rest assured that this part of the birth process is VERY short-lived compared to your whole labor.

There are a couple of ways you can approach the ring of fire:

  1. Push as hard as you can to get through it quickly: This may increase your chance of tearing or having a more significant tear
  2. Shorter, more controlled pushes: You are less likely to tear, but you will experience the ring of fire for a longer period of time

It can definitely be hard to prepare for how you will handle this situation, should you experience it, until you are in the actual moment, but it’s something good to keep in mind.

The more you know!

Now that we’ve covered the ins and outs of pushing with an epidural, including the pushing stage of labor, productive labor positions with an epidural, what to do when pushing isn’t going well, and how much pain you can expect to feel when pushing with an epidural, I hope you find yourself adequately prepared for what pushing with an epidural looks like. 

There is a misconception that women with epidurals can only push on their backs, but that is far from the truth. While you will be slightly more limited with an epidural in place – having an epidural does not mean that you must push lying on your back.

 I encourage you to break down this misconception with anyone that tells you otherwise, now that you are an expert.

Thinking about an epidural for your birth? 

To learn more about epidurals, including when to get an epidural, how an epidural works, and epidural side effects, I encourage you to check out some of my other resources below.

My online birth class, Birth It Up: The Epidural Series course covers all these topics and so much more so definitely check that out and feel free to shoot me a message if you have any further questions (IG handle: @mommy.labornurse).

You can also learn more on the blog and podcast:

Cheers to an even better birth, mama!

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Liesel Teen, BSN-RN
Founder, Mommy Labor Nurse

Meet Liesel Teen

Hi there. I’m Liesel!

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!

When you know what to expect and have the tools to navigate the experience, you’ll feel confident and in control.

I believe you deserve a better birth — no matter how you deliver.