Creative Pushing Positions

[LizzyL&DRN]

Here's the scenario: Term pregnancy, no complications, primip, completely dilated, +2-3 station, mom has an epidural but cannot feel the urge to push but can lift her legs, she does however push very well for a primip who can't feel anything. Anyway, mom pushes a couple of times and baby has some prolonged late decels down to 80s-90s with somewhat of a slow return to baseline. We change her pushing position to each side, but no improvement with pushing. So I call the doc to come because I don't feel comfortable pushing her anymore. Doc puts a vacuum on the baby's head and baby is born rather quickly with 8/9 apgars. My question is: Are there any other positions that we should have tried to have mom push in? I've heard of ladies pushing on their hands and knees? But with an epidural? I just don't like to see vacuums on baby's heads and always try everything I can to get that baby as low as possible so it's not needed. Obviously we had a good outcome in this case but for future reference what should I try next time? Thanks again for your input.

[lisamct]

Ive had mums pushing on their hands and knees with an epidural if they still have some feeling in their legs. Usually we'll try mum on the bed facing the pillows, head of the bed raised and a huge pile of pillows for mum to lean on. They can get into quite a stable position with their knees quite far apart. Getting into this position seems to help babies get 'round the bend' as well so may have helped the effectiveness of her pushing.

Ive also once had a mum with an edipural out of the bed on a floor mat with her husband kneeling behind her and her in a sort of squat but sitting on his knees and leaning back on him (using him a a sort of human birthing stools) That worked really well for her but Ive never had anyone else keen to try it since. He did get totally soaked when her waters broke as the baby crowned mind you, not sure if he'd be keen to do it again either!

Neither may have helped in your situation but its always worth a try.

[CEG]

Penny Simkin has a great presentation on supporting the woman with an epidural on her website: http://pennysimkin.com/articles.htm . It has a lot of pictures of different positions to try and suggestions regarding epidural use and encouraging functional labor- pushng on the back is bad physiologically anyway, but epidurals encourage persistent OP/ other malpositioning and decreased maternal pushing ability= cesarean.

[NurseNora, BSN, RN]

If the patient had an epidural, you could let her "labor down" without pushing. It's amazing how well some babies move down with just the strength of the contractions without the added stress of the pushing efforts. And it's easier on the baby.The decelerations with pushing are often from the mom's forceful, prolonged Valsalva which decreases maternal cardiac output, thus decreasing fetal oxygenation.

Many patients with epidurals can push very well on hands and knees. They seem to be able to balance pretty well with the aid of pillows and whatever as others before have described.