Top Three Mistakes First Time Moms Make with Epidurals

I’m all for making informed decisions for your birth. Some people go into it planning on getting an epidural. Some people thought they’d never want one, but end up choosing it because it’s right for them in the moment. Whatever you choose, I hope your choices aren’t out of fear. 

Epidurals can be such a loving choice.

Arm yourself with knowledge before you’re in labor so you can know your options! 

#1 Mistake: Getting an Epidural Too Early

If you CAN wait until active labor (6cm or further dilated) with consistent contractions, that will help. 

Once you get that epidural, you no longer can get in the shower to manage pain. You can’t sit on your birth ball and sway your hips. You can’t stand or squat and get up to pee. 

You are in the bed until baby comes.

Which is fine if that’s the right choice for you, but if you can let gravity be on your side by being up and out of the bed, it’ll help things to progress.

If you’ve hit a point where you are in agony and cannot relax and release through the contractions, an epidural will help you to release those tight muscles, helping labor to progress.

I had a client recently hire me for her second birth saying that she felt really rushed into her epidural with her first. The nurse told her they were really busy that day and that she should get one while the anesthesiologist was available. She felt like she didn’t really have a choice. With an effective doula on your team, she will help you navigate these choices so you don’t have to make decisions out of a) a lack of options or b) out of fear.

You never know how long it might take from the time you ask for an epidural until the anesthesiologist comes to your room (typically, the fastest is 30 minutes because they need to give you a bag of fluid before placement). But the hospital being busy is not really a reason to get an epidural unless you’re pretty close to thinking you’ll want one. This particular mom didn’t plan on getting one at all, but felt pressured into it.

Your brain processes things differently in labor. You aren’t thinking as you normally would. So it’s important you talk about your options prenatally, and that your partner knows your wishes. 

I tell people to think of a safe word for when they really mean they want it. When your partner hears “ashtray,” they know not to try to talk you out of it; not to remind you of all the reasons you didn’t want it originally, and they call the nurse to get it.

Mistake #2: Not Changing Positions Often Enough

Whether you feel it or not, your body is still running that labor marathon, expanding massive amounts of energy. You definitely need to rest and sleep.

But the worst thing you can do is ONLY lay back and stay that way for hours. 

Get a chunk of sleep and then aim to change positions every 30 minutes. Your doula  can help choose positions for you if you are unsure. Sometimes it’s literally switching sides, but what you do with that peanut ball matters. 

Sometimes having someone rock you back and forth gently during the contraction is helpful. All of my clients receive a guide to birth that includes birth and pushing positions with and without an epidural. Trying these positions BEFORE labor helps you gain access to these positions and they seem less awkward while in labor. 

Have you heard of Flying Cowgirl?

Your baby has to navigate down through your pelvis. 

Picture those labyrinth games you played with as a kid- to move the ball to the middle, you needed to move the board around. Your pelvis is the board and your baby’s head is the ball. 

To Move Baby, We Have to Move Mom! 

Mistake #3: Thinking An Epidural Means You Won’t Feel Any Pushing Pain

Spoiler Alert: you’ll have sensation. It varies by person, but so many moms are surprised by the “pressure” they feel as baby moves down and they need to push. Not everyone would categorize this as pressure. I’ve had plenty of clients call it pain. 

When you get an epidural, you are given a bolster button. The epidural gives you continuous medication, but they tell you to hit the button if you need an extra dose. Don’t worry- you can’t give yourself too much. There is a “lock out” time where if you hit it twice within 15 minutes, it will not give you that second dose. It's a good option if you’re having contraction pain, but it doesn’t really help that pressure sensation of your baby moving down and out.

That epidural is good at numbing the contraction pain, but not so great at numbing the feeling of a bowling ball coming out of your butt (your baby’s head putting pressure on your rectum). 

I hate the calling it The Ring of Fire and I reframe it as the Ring of Power (yes, I love LoTR). The one true ring! Most women with an epidural are not numb to the feeling of the baby’s head crowning. 

I had an epidural with my first baby and pushed for 4.5 hours. At one point, the midwife tried to turn the baby from OP (sunny side up, or baby looking up towards my eyes) to OA (baby looking towards my butt). 

I felt the pressure of the baby coming down, but I felt the need to poop the entire labor because of her positioning. I highly recommend doing Spinning Babies Three Daily Balances starting at 28 weeks to get your baby in the best position before labor begins. 

My daughter wouldn’t turn and eventually was born staring into my eyes, ready to meet me. Once her shoulders were delivered, my midwife told me to “reach down and catch your baby,” as I requested on my birth preferences. It was so healing and amazing to catch my own baby! Whatever feeling I had with her crowning melted away from memory as I scoped her up and onto my chest.

For that second birth, I never felt what people describe as the ring of fire. I just felt my baby coming. It’s an intense sensation, but not one I was afraid of. The more you can think of it as the last bit before your baby comes, the better off you’ll be. 

I’ve been at births where the mom was terrified of this feeling and kept asking me while pushing, if she was close to feeling it. That fear may have weakened her pushes and prolonged her labor. 

It’s ok to take breaks during pushing. But if you have a big fear of tearing or the ring of fire, it’s important to talk through those fears prenatally. I’m with Mr Rogers in his philosophy that making things mentionable (talking about feelings) allows time for them to be manageable (if you talk to your doula/birth team about these fears before you’re in labor, you have time to process them and hopefully release them). 

Conclusion: 

This post went over the top three mistakes I see first time moms make when getting an epidural.

Getting the epidural too early prevents you from moving around outside of the bed. 

Not changing position enough will slow down your labor. To move baby, we need to move mom! 

And finally, the mistake of thinking an epidural will take away all pain of labor (especially that feeling of baby coming down to crowning). While it can help, it doesn’t usually numb everything. And we want you to have some feeling in your bottom so that you’re able to push more effectively. 

For more information on whether or not choosing an epidural is right for you, visit my blog post Is Unmedicated Birth Worth It?