Med-free vs. Medicated Pushing

ST3WD

I've been searching trying to find something on previous posts, but I haven't found an answer yet.

One of the biggest reasons I'm interested in a med-free delivery is how some women claim they push more efficiently. The handful of ladies I know who didn't receive an epi all seem to have shorter pushing times and were able to respond to the sensations they had from having all their feeling. Most of the others however, who opted for the pain relief, all seemed to push closer to the norm of several hours. Maybe because they had to be coached or could only feel pressure. Who knows? I understand all labors, babies, mothers, etc. are different, and that the times could be from exhaustion, not being able to relax between contractions, or any number of other reasons. 

My question is: Have any of you delivered with both an epi/pain relief AND med-free for separate births? Did you find yourself more efficiently pushing without the meds/was it more difficult to gauge how you needed to push with the meds? 

(I'm not sure if this is even an issue, but I'm trying to do as much research as possible.) 

LilTiger15

I haven't done both.  I had a med-free birth for my first and one of the reasons was the reason you brought up.  Not so much because I thought it would shorten the time I would push, but because there is much less chance of tearing.  Think about it--if you can't feel anything down below and all you hear is 'push!' 'push!' 'push!'....you are going to push like crazy.  Your body has no way of telling you that you should actually let up a bit if necessary. 

A woman doesn't typically need to be coached on when and how to push.  She instinctively will feel when and how to push.  Doctors/nurses had to start 'coaching' because the norm is now to be medicated and if you are completely numb down below, your body isn't signaling when to push. 

I am a small person.  Pre-pregnancy, I was 115 lbs 5'5" tall.  My son was born at 41 weeks and weighed 9 lbs 5 oz.  He was also born posterior with his arm across his chest.  I made it clear on my birth plan that I did not want an episiotomy.  Thank God I made that clear.  I didn't have any external tearing.  I guarantee you, if I had that epi and with the circumstances at hand with the baby's fetal position, I would have torn like crazy. 

catsinawindow

I had a epidural with DS and an unmedicated birth with DD.  Pushing was much faster with my DD (12 minutes with DD compared to >3 hours with DS).  Probably some of this was due to the epidural/not having an epidural but I don't think all of it was.  Pushing my DS felt very similar to pushing with my DD (my epidural at least partially wore off at the end, in fact they needed to give me extra meds afterwards because I could feel them stitching me!)

I felt like a big difference was that I requested self-directed pushing with my DD and moved around to find the most comfortable position to push in.  It was interesting, I JUST KNEW when I got into the best position, and it wasn't the position I thought I would be pushing in!  For me, I feel like the counting, breath-holding, holding my own legs pushing that I did with DS was counterproductive.  I was wasting all my energy holding my breath and holding myself up that I didn't have as much energy to direct the pushes.  With DD, I laid on my side and my DH and nurse held my leg and I did the frequent, short pushes that felt right.  This was much, much more productive for me.

CLLDLL

I had an epi with my first and no meds with my second. Hands down pushing was easier with DS2. I pushed twice whereas with my epi I pushed for about an hour. I think some of the difference was first vs second birth, but also I definitely felt where to push and how hard and when without the epi. With the epi I did the whole hold up your legs, bare down, count and push with DS1 and I really did feel like it was the Dr./nurse in control instead of me. With DS2 I told them when it was time to push. I pushed for how long and how strong felt right to me. I got up and walked to the nursery within a couple hours after birth and overall my recovery was easier the second time.

mrsblueeyes

I had both.  My first was with an epi. Even though I couldn't feel my legs at all I  still felt the urge to push with the epi and baby was out within 2 sets of contractions.   With my second I got an epi late and though it took the edge of the pain I could easily feel the contractions, descent down the canal, and I had a distinct urge to push at the end of each contraction.  She was a little larger in size so the OB was content with waiting for her to move down on her own and stretch things out. She was out within 20 minutes. 

My last was unmedicated and surprisingly I didn't feel the urge to push.  I started pushing involuntarily and the baby was out 2 contractions later.  I'm thinking because my water hadn't broken with #3 until he was born the bag of water might have been blunting some of the pushing sensation.  Just a theory.  Good luck with your med-free delivery!

JCWhitey

I've only had one kind but this was an interesting read!  I'd be curious to see who had a med-free birth first and then an epi with the second.  I wonder if their experience would be different since it was second delivery over first.

For me, I wasn't that in tuned with my body as some ladies!  I had no clue where DS was as he was coming out and it actually surprised me when the doctor said he'd be out on the next push.  I did know exactly when I needed to push and would push when a contraction started and stop when it finished.  I was encouraged to get to 10 seconds, but sometimes would go longer, sometimes go shorter.  I figured whatever I was doing was effective enough because that's what my body was telling me to do.  I pushed for 45 minutes.  No tears, although I'm a little surprised by that because at the end I really wanted to just get him out so that last push was kind of a "JUST GET OUT!" type push!

painttheair14

First birth I had an epidural and pushed for an hour with tons of tearing. Like, it was really bad.

Second birth was at home and my body pretty much pushed for itself without much effort on my part. It was only 5 minutes and I only had a tiny tear that didn't require stitching.

I'm sure not all of that is because of the epidural, but I feel like a lot of it is.

soulcupcake

I had a very late epidural with dd1. I began feeling pushy at 8.5 cm, and couldn't help but want to push. But I kept being told it wasn't time. The pressure was intense, especially not being "allowed" to push or get into a position to allow her to descend. The nurse said the epidural would take a lot of that pressure away since I still had two or so hours to go. (contractions started at 7.5 cm)

The hospital cut off was 9 cm, but the time between consenting to it and getting it was 45 minutes. I was checked 20 minutes after it was in and was complete. That's also when I began developing a headache and feeling itchy all over.

I labored down for more than 30 minutes before beginning the second stage. I pushed a few times and she was born. She was 9 lbs. I was told, and had known that being a primip that it can be normal for the second stage to last 1-2+ hours. To my surprise it was over in a couple minutes.

#2 was med-free, and I also started labor in transition. About 5 minutes before her birth I was 8 cm, 0 station with a contraction and -1 without, with a cervical lip. I didn't really have a second stage with her. She was born very rapidly. I felt her descend as soon as I was attempting to get out of bed to head back into the shower.

I felt pressure, and then the nurse asked if it felt like I had to push, and a few seconds later we knew she was coming. Before this I wanted to try either squatting or all fours, but upon her rapid descent there was no time to get in any sort of position other that sit back in bed. Her head was half way out as the midwife rushed back in and dropped the bed. She suggested light pushes, basically breathe the rest of her out to avoid major tearing (due to the force of her birth). I did get the experience of the "ring of fire." Yikes. That stung. She was 8 lbs., 9 oz.

#3 slid out with a gush of fluid. I didn't push or do anything. But he was tiny at 5 lbs., 4 oz.

#4 I skipped labor entirely and went from 6 cm to birth in four contractions (one minute). My uterus expelled him out. I didn't feel "pushy." It felt like he was barreling through, and I didn't have control of anything. I don't recall the "ring of fire," (happened so suddenly) but the amount of pressure, the force and intensity, yeah... crazy intense. He was also 9 lbs.

____________________________________

Those I know who have experienced both definitely prefer mother-led/spontaneous pushing over directed/coached. Push when you feel the need, when you feel the urge or when the baby is low enough in the pelvis for it to be effective. (and preferably in an upright position)

Novem06

With my first birth I received an epidural but it did not work (I have scoliosis in my lower back and they couldn't get it placed correctly). I pushed for an hour and a half and had a tear. I felt like I was clenching up thru the pain and not effectively pushing. I was also exhausted and felt like I never got a break as contractions came every minute. It was brutal and recovery was hard. With my second the epideral worked (after 2 failed attempts). I went from 5 cm to 10 in 20 minutes and buzzed the nurse when I felt pressure. Pushed for 10 minutes and she was out with no tearing. I went for a bike ride with my son 4 days later and recovery was a breeze. That being said...I'm still not sure which route I'll go for number 3. The epideral process gives me anxiety since I've had such issues in the past. I've been lurking on this board to see if I could handle going natural better than my first. I feel like the epi allows my body to relax and progress faster and I've done this twice so I know how to push. I'm worried about fighting the pain again and everything taking longer.

ST3WD

LilTiger15 Thank you! This made a lot of sense. I'm not especially worried about how long I push, but rather how effectively. I want to avoid being numb and thinking I'm pushing like crazy and having nothing happen because I can't tell. It's kind of a crapshoot anyway, since this is my first and I have no clue how my body or mind will handle L&D.

I just want to cause as little stress as possible to LO during the process, and figure that would be easiest if I can somewhat tell what's happening/listen to my body. If anybody had experienced both methods and didn't find it changed the effectiveness, then I would probably take it off my pros list for med-free. 

(Does this make sense? I don't know if I'm expressing myself correctly at this point.)

ST3WD

catsinawindow Oooooookay! I think I know what you guys mean now. It's more about being able to listen to your own body than what everyone is recommending, and less about how "effectively" one pushes. 

I believe this will remain on my list of pros.

ST3WD

CLLDLL Thanks for the response! It's inspiring to hear my instincts were on target. With the reading I've been doing lately, I think I will try for a med-free birth!

MsMacual

I have delivered twice med free so I can't speak to the difference between the two, but I will say that my second delivery was a lot easier because I didn't fight using the positions that were the most uncomfortable, but produced the best progress.  I think one of the challenges with an epi is that hospitals common require the mom to stay in bed so she is limited to pushing while laying on her back vs being able to move around and use positions that are helpful in getting the baby to move downward. 

jess9802

Honestly, I don't think comparing an unmedicated second birth to a medicated first birth is a fair comparison - it's fairly well known that second stage for multiparas will generally be shorter and easier than second stage for primparas.

FWIW, I had an epidural with DS. It did not stop me from feeling the spontaneous pushing that started when I was complete (which completely freaked me out), and I only pushed for about 40 or 50 minutes.

an02102

I had an epi for both births and I will say my second (30 min) was way easier then my first ( 3 hrs)  and DS 2 was 2lbs bigger.  I think some of it is that your body almost remembers how to do it and you can do things more efficiently the second time.  My sil went med free with her first and also pushed for 3 hrs.  

mrsmopar67

I pushed both of my kids out in a few minutes, no meds. I did also get second degree tears with both. Hoping to have a much more calm and controlled pushing stage with #3.

herecomesthesun086

mrsblueeyes said:

I had both.  My first was with an epi. Even though I couldn't feel my legs at all I  still felt the urge to push with the epi and baby was out within 2 sets of contractions.   With my second I got an epi late and though it took the edge of the pain I could easily feel the contractions, descent down the canal, and I had a distinct urge to push at the end of each contraction.  She was a little larger in size so the OB was content with waiting for her to move down on her own and stretch things out. She was out within 20 minutes. 

My last was unmedicated and surprisingly I didn't feel the urge to push.  I started pushing involuntarily and the baby was out 2 contractions later.  I'm thinking because my water hadn't broken with #3 until he was born the bag of water might have been blunting some of the pushing sensation.  Just a theory.  Good luck with your med-free delivery!

I just gave birth to my LO about five weeks ago without pain meds... I was induced and on Pitocin but had no urge to push when they were instructing me to push until the very end I had a good birth experience despite a couple minor complications but pushed hit three hours ...

herecomesthesun086

Also my water was broken ... Still didn't really feel the urge

JCWhitey

@metaphysique Those are some crazy labors!  Your first sounds a lot like mine minus I couldn't get the epidural (my hospital's cut off was 7 cm).  Contractions didn't really hurt at all, it was being told I had to fight the urge to push because I wasn't fully dilated yet.  I was stuck at 9 for 45 min-1 hour and just wanted to push the whole time.   I know now that those urges are there for a reason and light pushing isn't likely to cause harm.

ST3WD

JCWhitey I'm curious, did you labor in any specific positions? 

Maybe I'm just being naive, aren't there poses to help descent more than others? 

(Obviously ever baby/body's different, but if there's a book or website that explains advantages/disadvantages to laboring positions, that might help.)

JCWhitey

ST3WD said:

JCWhitey I'm curious, did you labor in any specific positions? 

Maybe I'm just being naive, aren't there poses to help descent more than others? 

(Obviously ever baby/body's different, but if there's a book or website that explains advantages/disadvantages to laboring positions, that might help.)

The better question is what position I *didn't* labor in.  I loved sitting on the toilet.  Lying in bed on my side felt good for a bit.  I tried the tub and felt constricted but it was nice for a bit.  I bounced on a ball, stood and leaned over the bed, laid backward on the ball (which freaked everyone out!), I think at one point I just dropped to the ground on my hands and knees... Seriously I switched it up every 3-4 contractions.  For pushing I did most of it on my back bacause that felt great.  For a few contactions I kneeled over the back of the bed but definitely felt better just lying down.