laboring on the back question, & epidural slowing labor?

Brenda-RN,BSN, WA. · May 5, 2004

I don't have a response to your first question, positioning, I am not an L&D nurse. However, your second question about epidurals possible slowing down labor, I do have a response! With my first, my water broke, I went to the hospital, was 1cm. I had to be 2cm in order to get my epidural. 4 hours later, still a 1, got some stadol, relaxed a little, I had pitocin, got to a 2, got my epidural and 1/2 hour later was complete, pushed 3 times and had my son in my arms. So, I think, at least for me, the epiduarl helped me relax so I could dilate. I was so tense from the pain, I just couldn't relax. I am not exagerating. My doctor barely made it on time to catch my baby! The nurses couldn't believe how quickly I dilated. So, that's my opinion. I have also heard that epidurals slow labor down, but not with me.

At my friend's delivery a couple of weeks ago my friend wanted to sit up a little bit (I think this was early pushing/ 'trial' pushing stage) and the nurse wanted her to basically lie flat so the baby could have room to 'get under the pubic bone'.
Is this something that any of you do in your practice? In what situations would you do this? I mean, it makes sense in a way (I had a should dystocia baby so I understand it). But obviously babies are born in all kinds of positions, and my friend didn't have any problems going on except slowish progress (arrived hospital 7am 1cm, water broken since about 4am, complete at 11pm with pitocin). I can't think of why you'd do it in a routine delivery.
On that note, I am also wondering anecdotally how many of you feel that epidurals slow labor? I think I've read that it isn't supposed to do so after active labor (i.e. after 4cm), but I know at least a couple of L&D people that clearly think it does. Like when I was going to have my third I would hear "oh, you are a multip going natural, you'll go fast", etc. (now I know there are no hard and fast rules, but I mean in general here).
My friend got her epidural at 1cm and I think that's at least part of why she was slow (this was a second birth).

rosieseattle, RN · May 5, 2004

Yes! I can't tell you for how many years I've seen it work sooo well to have a laboring patient in a completely flat position (for a while) during pushing. It works very well, and helps the head to descend under the pubic bone. I've also seen where midwives will have the patient use the birthing bar in early pushing and the head sits there for what seems like hours, stuck on the pelvic bone and the labia continues to swell and swell and the patient gets anxious, angry and exhausted.

On the epidural part....most birthing units have some parameters on the labor progress prior to epidural anesthesia to prevent slowing the labor process.

allnurses Guide · May 5, 2004

In my experience, which isn't as vast as Deb's or other nurses who do L&D all the time . . . epidurals seem to hasten dilation. I could tell lots of stories but I'll spare you those. It just seems that the women can relax, sleep and then their bodies just open up. It is amazing.

steph

SmilingBluEyes · May 5, 2004

yes epidurals CAN hasten dilation, in that they often really relax women. But applied too early, these can often really slow labor progress, as well. It just depends on the woman and her situation.

SmilingBluEyes · May 5, 2004

I NEVER have women push lying flat on their backs. It can cause vena caval syndrome and resultant decelerations/fetal distress. If a baby is "stuck" I would first try side-lying pushing, first one side, then the other, which can be a real boon to fetal descent. Or if there is no epidural she can sit on the toilet and with good results often. Also, hands/knees and standing/dancing positions are great, again in absence of regional anethesia, of course. But----Flat on her back? Nope not on my watch, NOT without a real good wedge under her right hip anyhow, which is not flat.