Birthing with an Epidural? Here's What You Need to Know About Laboring Down

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November 25, 2021

Hey Mama! Picture this: You’ve been handling labor like a birthing queen for hours and your provider does another cervical check. They pop up and you hear those glorious words: “You’re at 10 centimeters!” Woot woot! It won’t be long until you’re holding your baby. The finish line is within sight, and now it’s time to labor down….aka WAIT.

Gosh, it seems pretty anticlimactic when you put it that way! But keep reading and you’ll see why waiting it out will pay off in the end.

mama laboring down with epidural

Why I am here and who I am:

Hey mama, I am Trish— AKA Labor Nurse Mama. I am a labor and delivery nurse with over 15 years of high-risk OB experience. I am also a mama to 7 kids and have given birth to 6. I have labored thousands of mamas and delivered many, many babies. I am the online birth class educator for Calm Labor Confident Birth and The VBAC Lab birth classes. I am passionate about your birth and motherhood journey!

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If you’ve started the journey of preparing to bring your little one earth side, you’ve likely come across a myriad of terms and general timelines of the different stages of labor.

It can definitely be overwhelming to think of the big picture and how it all fits together. So, let’s break it down a bit.

And then chat about the process we call “laboring down”—specifically what it looks like to labor down if you’ve chosen the route of an epidural! 

Psst! A little side note: For an in-depth look at all things labor and delivery, check out the new and improved Labor Nurse Mama birth course to prepare for your confident, empowered birth! Can't wait to see you on the waitlist!
mama laboring down epidural birth

First things first: the epidural. It’s one of the most common forms of medication in labor, but how exactly does an epidural work?

Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body, with the end goal of providing “analgesia”—aka pain relief—opposed to true anesthesia that leads to a total lack of feeling. An epidural blocks the nerve impulses from the lower spinal segments, which results in a decreased sensation in the lower half of the body.

Receiving an epidural for a vaginal birth does not, under most circumstances, result in a complete lack of feeling. Not removing all of the sensations will allow you to maintain the mobility you need when it comes time for you to push, so the baby can make its grand entrance! Promise you, it’s a good thing—no need to panic, Mama! 

Now back to the idea of waiting.

Let’s talk about what it means to “labor down”.

Once you’re in active labor, your cervix will soften and start to dilate to prepare for the baby to make their way down into the birth canal. Once you reach the 10-centimeter milestone, it’s a good indication that the baby will be there so soon! 

But don’t pop the champagne just yet…

While some birth professionals believe that a Mama should start pushing right when she’s reached her peak dilation, this isn’t always the best option—especially with an epidural. Why? Because it doesn’t take into account her baby’s “station”.

Fetal station is significant! Especially when it comes to pushing. 

The station is measured by the top of the bony part of baby’s head (well, technically the presenting part of baby, but crossing my fingers and toes that baby is head down for you, Mama!) in relation to the Ischial Spine (aka the two bones in the pelvis). An imaginary “line'' is drawn between the ischial spines and this is the line that is considered the “Zero Station.”

If your baby’s presenting part is above Zero, it’s considered Negative, while anything below Zero is considered Positive. The scale goes -3, -2, -1, 0, +1, +2, +3.

For first-time Mamas, dilation and station often work hand-in-hand, but that’s not always the case! For some, you could be 10 centimeters dilated, but the baby is still comfy up high in your pelvic inlet. This means that if you were to start pushing right when you reached peak dilation, you would likely be pushing for a long time—a recipe for physical and mental exhaustion. 

labor down with epidural

So what’s a Mama to do? You guessed it: Labor Down—also lovingly referred to as the epidural slide! 

While it may seem counterintuitive to “hurry up and wait” now that you’re seemingly at the finish line, research shows that it can be in your best interest to let baby work their way down on their own. One study found that “Delaying maternal bearing-down efforts during second-stage labor until a woman feels an urge to push (laboring down) results in optimal use of maternal energy, has no detrimental maternal effects, and results in improved fetal oxygenation.” (PMID: 24781770)

When you are birthing with an epidural, laboring down helps you get the most out of the medication by keeping your body in its relaxed state as it does the work for you. You’re letting your body passively bring baby down where they need to be, allowing you to save your energy and *hopefully* spend less time in the pushing stage! Win win!

A quick note: It’s important to understand that it’s not always possible to labor down. There are sometimes situations where a baby may begin to show signs of stress—this is not the time to wait it out and your birth team will help coach you through pushing in order to ensure baby’s safety. Of course, the health and safety of Mama and baby are the highest priority when it comes to birth!

In my experience as a Labor and Delivery Nurse, the process of a Mama laboring down when she has an epidural is so helpful! Unfortunately, not all birthing providers are enthusiastic about waiting for you to feel the “urge” to push and may want you to push once you’ve reached the 10 centimeters mark.

But Mama, knowledge is power! Now that you’ve read the benefits of laboring down when you’re birthing with an epidural, you can feel empowered to request that you be given time to labor down and help baby get nice and low in your pelvis.

One way to make sure your requests are heard is by writing it in your birth plan!

Here’s what you can say: 

“If my baby and I are doing well, I would prefer to labor down and wait to begin pushing until my baby is at least at Zero station, but ideally +2, in order to conserve my energy and reduce the risk of exhaustion.”

It’s always a great idea to loop in your partner and anyone else on your birth team about your desire to labor down before pushing! This way, you can make sure you have others advocating for you in the event that your provider doesn’t typically take the time for laboring down. It is your big day and you deserve to have your wishes respected!

Hopefully by the time baby has made their journey low into your pelvis, you’re feeling that urge to push! It’s true that an epidural decreases a lot of the sensation in your legs, but it doesn’t mean you’ll be forced to deliver flat on your back. While some Mamas feel most comfortable on their back, using gravity to your advantage is another way to work with your body to get baby out efficiently.

Your nurse, doula or partner can help you position your legs in a way that helps to open up your pelvis. Work smarter, not harder—that's how you "hack" your birth!

You can find lots more tips for pushing in the Labor Nurse Mama “Purposeful Positioning” course—your one-stop shop for finding helpful positions for relief in pregnancy, labor and pushing!

laboring down to push baby with epidural

Labor is a marathon, not a sprint! But by all means, if we can shave some time off when it comes to getting to the finish line, who would be opposed to that?

So while hearing those beautiful words that you’ve reached 10 centimeters will be music to your ears, waiting until baby is nice and low in your pelvis will help you stay in the zone and avoid exhaustion when it comes time to push. Laboring down will help your body passively do the work for you as you sit back and take a breather before the main event. Three cheers for the epidural slide!

"Hurry up and wait" may be the name of the game, but Mama, it won’t be long—the finish line is in sight!

You got this!

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This group, board, and guidance have been absolutely invaluable.

I was extremely comfortable asking questions, making decisions and even though nothing went according to my "plan", I couldn't be any happier with the way everything went!!!
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