Pushing/delivery positions and epidurals

HappyNurse2005, RN · Apr 30, 2007

leaning on bedside tables might not be a great idea, b/c they have wheels!

depending on how strong her legs are, she could be up on her knees, leaning over a squat bar, laying on her side with her upper leg held up, i've had a lady with an epidural on her knees backwards in the bed over the back of the bed, so it was a squat of sorts. she wasn't pushing, she was attempting to rotate her OP baby.

i suppose it really depends on how strong her legs are and her feeling and ability to push.

NPinWCH · Apr 30, 2007

I've found that if they can get into the position, which depends on how heavy the block is, getting them onto their knees while using the back of the bed to support their upper body works pretty good. You can also sometimes get them up leaning over a smaller "birth" ball while on their knees. Try putting them into a sitting position while dropping the foot section of the bed and allowing them to lean against the squatting bar.

The "tug of war" works pretty good if the block is too heavy. I like to put the squatting bar in, have a couple people hold their legs back and tie a draw sheet to the squatting bar. They then play tug of war with the sheet and curl themselves up around the baby. This one seems to really help the girls who can't figure out how to push or can't feel enough to push well.

You can also turn them onto their sides and use one stirrup/calf support to hold the upper leg in place. To get the support into the right place you may have to lower the foot of the bed.

I really like to put my epidural patients into high fowlers with the foot of the bed lowered some and let them labor down as far as possible before starting to push. Usually, they end up starting to feel pressure as the head descends and it saves them some effort pushing.

SmilingBluEyes · Apr 30, 2007

What rninwch said.

CEG · Apr 30, 2007

thanks for the great replies. I thought the bedside table thing seemed like a bad idea too so I didn't want to suggest that. Thanks for better ideas! Hopefully my presentation goes well.

magz53 · May 1, 2007

Just be careful positioning someone with dead legs. We have had several nurses hurt........2 out permanently with back and shoulder injuries. Use the birthing bed with all of its gadgets if possible. Or put a couple of the 14 people in the room to work holding legs......they are always surprised that it takes so much effort......especially when the patient pushes against you. I have already had back surgery and am not anxious to go that route again. The hospital does not stand behind you in an injury if you have not utilized all available equipment. No one wants stirrups as it is not "natural". HELLOOOOOOOOOO you have an epidural, pit, IUPC, internal lead, foley catheter, continuos EFM and are a social induction.........you left "natural" a long time ago !!!

JoniL&DRN · May 4, 2007

We like side lying and it seems to work. Some women seem to be able to curl around and get in the zone a little better on their side... boy it starts to hurt your arm though if you're the "leg holder"!

SmilingBluEyes · May 4, 2007

I am happy to ask able family members hold legs, or use the stirrups for that purpose. I am one who wants to save her own back, and being small of stature/size, I am not gonna last, holding 50 or 75 lb dead legs day in and out. No thanks.

CEG · May 4, 2007

Thanks everyone for the suggestions. The presentation went well. The educators seemed really excited, too bad I won't be around to see if there is any change.

33-weeker · May 5, 2007

having some med-surg history, i know there are such things as post-op or 'walking' epidurals. it all depends on the amount and combinations of meds injected. why can't these be used for laboring women? anybody know the answer?

JoniL&DRN · May 5, 2007

That's a good question... That is the kind of epidural I had with my first delivery. They referred to it as "walking" and you were able to retain much of your sensation in the lower extremities (in fact a good deal of it OUCH). I suspect that is the very reason we DON'T use them! Those who want an epidural usually WANT to be numb! Thus the reason for the anesthesia in the first place.

Selke · May 5, 2007

Is the walking epidural similar to an ITN (intrathecal narcotic), which is like a spinal, mostly fentanyl with a bit of bupivacaine? The place I'm working at now does mostly ITNs, very few epidurals, because the anesthesiologists or OBs don't want to stay in house for an epidural as they are required to. ITNs seem to work well if you deliver before it wears off, and you have fewer dead 100 lb legs, easier for the woman to push.