If you have an epidural, you may feel pressure, an urge to push, or no sensation at all—depending on your situation and the strength of the medications in your epidural. In contrast, most people who give birth unmedicated (without an epidural) experience a strong urge to push.
The Urge to Push With an Epidural
Sometimes this urge is overwhelming and women describe it as something that their body is doing and they have no control over it.
The local numbing agent alleviates most of the pain you may feel during the epidural. Most women feel pressure and a stinging sensation as the epidural medication is injected through the needle.
The pushing stage occurs after the cervix is completely dilated and no longer in front of the baby's head. A smooth passageway now exists through which you can push your baby from the uterus and down through the birth canal to delivery. Your contractions may decrease just prior to getting the urge to push.
This anaesthetic usually blocks pain from labour contractions during birth very effectively. With an epidural you can usually still push your baby out when you need to. An epidural is usually done by an anaesthetist.
You can still feel some pressure of contractions, but you don't have constant pain going through your entire body. Study participants said having an epidural had a positive impact on their birth experience, changing their challenging situations into something manageable and even enjoyable.
For many people the act of bearing down and pushing also feels like having an intense bowel movement. (In fact, it's pretty common to actually have a bowel movement during labor, as you use the same pelvic floor muscles to deliver vaginally.)
Most pregnant people begin pushing once their cervix dilates (widens) to about 10 centimeters. This is the beginning of the second stage of labor, when your baby starts moving out of your birth canal. But some people may not feel the urge to push for one to two hours after the second stage begins.
To keep yourself from pushing, you can do breathing exercises, or lean back and try to relax the muscles of your perineal floor. Feel free to change positions during the pushing stage. You may become tired in one position, or you may feel that another position – something more upright, for example – is more productive.
Nurses aren't necessarily being cruel when they instruct mothers to stop pushing, by the way. They may be hoping to prevent other complications, such as problems with the umbilical cord or shoulder dystocia. A doctor or midwife is better trained to correct such situations, and can also help prevent perineal tearing.
The epidural blocks pain by numbing the lower body, but this often reduces the effectiveness of the mother's efforts to push during contractions.
Sometimes oil of peppermint works. You can put a few drops on a cotton ball and sniff it, or you can put it in the toilet water, • If you had a dense epidural—or “heavy” block, you may not have a sensation to urinate for 6-12 hours. You should ask for a catheter if you don't have any sensation to urinate.
Most of the time, you can walk within a half hour or so of your epidural injection. However, you will not necessarily be walking normally at this point. Most clinics and hospitals monitor you for 15 minutes to an hour after an epidural injection. During this time, they will likely ask how you feel.
If you're 4cm dilated and feeling a strong continuous urge to push (very unlikely) - then that's not ideal…often any pushing urge this early passes if you change position. But if you're close to 10 centimeters dilated the research suggests it's not an issue.
Delayed pushing had some adverse consequences. Four percent of women who waited to push had excessive bleeding after delivery compared with 2.3 percent who pushed right away. The delayed pushers had more bacterial infections: 9.1 percent versus 6.7 percent of the women who pushed immediately.
The Urge to Push
Once in active labor, most women will feel a strong natural urge to bear down. This is generally caused by the baby being pressed onto the Ferguson Plexus of nerves, creating Ferguson's reflex: the urge to push.
With epidural anesthesia, pushing can be delayed up to 2 hours for nulliparous women and up to 1 hour for multiparous women (Hansen, Clark, & Foster, 2002; Simpson & James, 2005). There are two phases to the second stage of labor: the initial latent phase and the active pushing phase (Roberts, 2002).
More rapid, intense contractions; a powerful "opening up" feeling; and rectal pressure are signs that you are completely dilated and ready to push your baby down through your vagina (birth canal) and give birth. You may urinate or defecate involuntarily.
Pushing can be one of the most intense and exhausting parts of the labor and delivery process—and it can take anywhere from several minutes, up to a few hours to push your baby out.
For most people, active labor is more painful than pushing because it lasts longer, gets more and more intense as it progresses, and involves many muscles, ligaments, organs, nerves, and skin surfaces.
In most cases, an epidural gives complete pain relief. It can be helpful if you are having a long or particularly painful labour. An anaesthetist is the only person who can give an epidural, so it will not be available at home.
While the experience is different for everyone, labor typically feels like extremely strong menstrual cramps that get progressively more and more intense as time goes on1.
You won't feel any pain during the C-section, although you may feel sensations like pulling and pressure. Most women are awake and simply numbed from the waist down using regional anesthesia (an epidural and/or a spinal block) during a C-section. That way, they are awake to see and hear their baby being born.