Doctors have to wait until the cervix is at least 4 centimeters dilated before doing an epidural. Otherwise, the epidural will slow the process down too much. However, once the cervix becomes fully dilated it is too late for an epidural to be given.
Recent research has suggested that 6 cm of cervical dilation should be the threshold for the active labor phase, and it has confirmed that epidural analgesia (EA) is a safe method of pain relief during labor.
Typically, you can receive an epidural as early as when you are 4 to 5 centimeters dilated and in active labor. Normally, it takes about 15 minutes to place the epidural catheter and for the pain to start subsiding and another 20 minutes to go into full effect.
You may request an epidural at any time during your labor. However, it is important to remember that it may take up to 15 minutes to experience pain relief from an epidural. In late first stage of labor when women have more intense pain, a spinal or combined spinal- epidural (CSE) technique may be performed.
Doctors have to wait until the cervix is at least 4 centimeters dilated before doing an epidural. Otherwise, the epidural will slow the process down too much. However, once the cervix becomes fully dilated it is too late for an epidural to be given.
You do not want to do it too soon because that can slow down early labor. However, if you wait too long, it can be hard for you to be still enough to get the epidural. The ideal time for an epidural is when you are around 4 centimeters dilated and still have a couple of minutes between contractions.
A new analysis contradicts previous findings that giving an epidural too early can prolong labor and up C-section rates. Let each patient decide when to have an epidural during childbirth. That's the advice of the Cochrane Pregnancy and Childbirth Group based on a recent meta-analysis.
The cervix must be 100% effaced and 10 cm dilated before a vaginal delivery.
During the active stage of labor, your cervix dilates from around 6 cm to the full 10 cm. (The last part of active labor, when the cervix dilates fully from 8 to 10 cm, is called transition.) This process takes about 5 to 7 hours if you're a first-time mom, or between 2 and 4 hours if you've had a baby before.
Getting up and moving around may help speed dilation by increasing blood flow. Walking around the room, doing simple movements in bed or chair, or even changing positions may encourage dilation.
A fully dilated cervix is 10 centimeters open. This means that when your cervix is measured with two fingers, they can be stretched 10 centimeters across. When you're fully dilated, it's time to push and have a baby.
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).
Until recently, women have been asked to start pushing as soon as the cervix has dilated to 10 centimeters, but as long as you do not have a fever and your baby's heart rate is normal, there are many benefits to waiting to push until you feel the need to push.
Transition typically lasts 30 minutes to 2 hours as your cervix fully dilates from 8 cm to 10 cm. Contractions will last roughly 60-90 seconds with only 30 seconds to 2 minutes between.
In general, once the active stage of labor kicks in, it's a safe bet to expect a steady cervical dilation every hour. Many women don't start really dilating more regularly until closer to around 6 cm. The first stage of labor ends when a woman's cervix is fully dilated to 10 cm and fully effaced (thinned out).
If your water (aka “amniotic sac,” “bag of waters” or “membranes”) hasn't broken on its own when you arrive at the hospital, and you're five or more centimeters dilated, your OB might recommend bursting the bag by hand—especially if your cervix seems to be making slow (or no) progress.
They found that women who had an epidural had a second stage of labor that was two hours longer on average than those who didn't have an epidural. The thought is that because epidurals cause numbness from the waist down, it may be harder for women to push effectively.
The most common reason for women to be denied an epidural is because of a lack in midwife numbers.
But if you're close to 10 centimeters dilated the research suggests it's not an issue. Evidence suggests it's more of a theoretical fear that just adds additional stress and in some cases results in an epidural (or a higher dose of epidural) to mask that urge.
The length of this stage varies with the position and size of the baby and your ability to push with the contractions. For first-time mothers the average length of pushing is one-to-two hours. In some instances, pushing can last longer than two hours if mother and baby are tolerating it.
Stage two: full dilation and pushing
Once the cervix has reached 10 cm, it is time to push the baby out. Contractions continue but also produce a strong urge to push. This urge might feel like an intense need to have a bowel movement. This stage can last anywhere from a few minutes to a few hours.
You can still push in all sorts of positions even with an epidural! At a minimum, you can push on your side or with support under your back to still make space for the sacrum. If you can move, you can even try all fours or kneeling, using the back of the bed as support!
Your cervix is also dilated by around 4 to 7 centimeters. Someone who has never given birth before may be in active labor for around three to six hours; a person who's done it before might take one to three hours.
Ellson explains that movement can boost oxytocin, which will lead to stronger contractions and quicker cervical dilation.
Try being upright
One of your biggest allies is gravity. When you are upright—standing, sitting or kneeling—the weight of your baby presses on the cervix, encouraging it to open. An upright position may also help get your baby into the best position for birth.