Epidurals in labour: Is it better to delay pushing?
Waiting longer to start pushing in labour with an epidural could add about one hour of waiting to the length of birth. However, it might not have major advantages or other disadvantages.
Epidurals are a popular choice for pain relief in childbirth. You can read more about epidurals in our Fact Sheet. Epidurals relieve pain effectively, but one of the disadvantages is that some women lose the urge to push. This can lengthen the second or pushing stage of labour, which can increase the risk of needing a so-called 'instrumental delivery' or assisted birth. That means a birth where forceps or a vacuum extractor is used to help with the baby's birth.
One of the recommendations made to try to avoid this is not to start pushing early. It is not clear exactly when the best time to start pushing is, especially when the woman does not feel an urge to push. Some midwives and doctors encourage the woman to start pushing when the cervix (opening of the womb) is fully dilated or open. Other midwives and doctors wait until they can see the baby's head, or when the baby seems to have stopped moving down.
To try to answer the question of whether it is better for a woman with an epidural to start pushing early or to wait, researchers from the University of Sydney analysed nine trials involving nearly 3,000 women with epidurals in labour.
The trials showed that getting women to wait until the cervix was completely open added an average of almost one hour to the length of the birth. This did not mean that the time pushing was increased: the extra time was spent waiting.
The researchers who did the trials did not ask women how they felt about their births, so it is not known whether women with epidurals prefer early or delayed pushing.
Delayed pushing did not have an overall impact on the rate of assisted births. Delayed pushing did reduce the rate of more complicated forms of forceps, but the difference was not large. There were no other definite differences in outcomes like caesarean section or the condition of the baby as a result of delaying pushing.