One of the biggest misconceptions we encounter when it comes to epidurals for labor is the idea that you can’t move once you have one. If you’ve taken our birth class or have been doing research on your own, you may be learning all of the movements and positions that you can use in labor. It’s true, many of them involve standing, squatting, all-fours and other upright positions. This often leads people to second guess their desire to get an epidural. But you may be sold on the idea of having an epidural as part of your labor. Epidurals can be an incredible tool that helps many people achieve an empowering birth!
Does movement get thrown out of the window the moment you decide to get an epidural? Absolutely not!
There are countless positions, and even active movements, that can be done with an epidural. Your birth doula is an expert on these, and will assist you in “keeping it moving!”
First things first: you get the epidural, and your nurse instructs you to lay flat on your back. This might not seem conducive to labor progress, and that’s because it’s not. However, it is an extremely important part of the process, because it allows the medicine from the epidural to spread evenly throughout the epidural space in the back, providing adequate and even pain relief throughout the body. This is because the medicine tends to follow gravity: if you lay on your right side for a long time, you will start to get really numb on that right side, and might even feel pain on the left.
Depending on the dose given, where you are in labor, and your anatomy, it may take 10-30 minutes to feel the full effects of the epidural. While you wait for that epidural to take effect, you can still change the position of your legs a bit. Even the slightest movement of laying with your legs flat, toes and knees pointing to the ceiling versus legs flat, toes and knees pointing to the side walls can change the space for your baby while you wait. Once an even level of numbness is achieved, then you can start changing positions. I recommend you ask your nurse when they think it is a good time to move from that flat-back position.
Now the fun begins. There are four main positions you can do while in a labor bed with an epidural
And there are plenty of variations within those four main positions. They are: right side-lying, left side-lying, upright, and forward leaning.
Side-lying with an epidural
While in a side-lying position, you can change the shape within the pelvis (think: giving baby space to rotate and move down!) by changing the position of the legs using stacked pillows or a peanut ball between different parts of the legs. Learn all about how we create space in different parts of the pelvis by taking a King of Prussia Doulas Childbirth Education Class! One of my favorite moves as a doula and a nurse is peanut ball rocking: while in side-lying, enlist a support person to gently rock the peanut ball back and forth during contractions, and just picture your little one tucking and wiggling their head, assisted by the movement you’re creating!
Upright labor positions
To move upright, the head of the bed should be inclined as far as it will go, and the foot of the bed can be dropped down (but this is not always necessary). Place extra pillows behind the back to achieve that completely upright position. Now, the position of the legs can be adjusted in countless ways: Plant your feet wide on the bed and point your toes away from the body for a supported squat, bring your feet together and let your knees extend for a butterfly-type position, use a peanut ball or pillows to create asymmetry, or point the toes in and let the knees come together to open the pelvic outlet. You can even attach a squat bar to the bed and use it to come into a supported squatting position.
Forward Leaning
Moving into a forward lean, or hands-and-knees position, will require support from your doula and/or nurse. If your legs are completely numb, it may be necessary to have your epidural rate adjusted–discuss this with your nurse. Using your upper body strength and their support of your lower body, it is possible to turn over to face the bed. A comfortable place to start is often with the head of the bed elevated so you can lean on it and rest your head and upper body down on a pillow or two. Again, the legs can be adjusted as needed, and you can even get into a lunge in this position!
Epidural Pro Tip
Remember not to spend more than 30 minutes in any one position. This is necessary to keep the coverage from the epidural working well, and will aid labor progress too. A win-win!
As you can see, movement is not only possible, but just as beneficial after getting an epidural as it is before. Having a doula with you will ensure you are never at a loss for your next position. Happy moving!!
Danielle McFadden RN
