Creative Pushing Positions

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.

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.

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.