Making the Most of Your Epidural

Epidurals can be an incredible tool for comfort and endurance in labor. The goal is relief from contraction pain however you may still feel pressure (especially later), which actually helps you push effectively. Here’s how to get the most benefit, stay safe, and keep labor moving.

Get Comfortable (and Speak Up)

Epidurals should make your contraction pain quite comfortable, especially early in dilation. If you’re still feeling significant pain after placement or the relief fades quickly, ask your team to reevaluate. You deserve effective relief.

Focus on Rest

I’ve watched many exhausted clients finally relax after an epidural—then stay on their phones instead of sleeping. Please don’t! Use this window to sleep, rest, and recharge for the pushing stage and the first hours with your baby.

• Dim the lights, silence notifications, and settle in.
  Ask visitors to hold questions and conversations so you can nap.

• Ask for help with discomforts and annoyances, monitors, cords, alarms, etc.

• You may be itchy due to the narcotics.  Try to avoid scratching, instead use things like cooling pads or wet washcloths till the feeling passes.

Keep Changing Positions

Some teams prefer you stay on your back for the first ~30 minutes after placement. If that’s the case, watch the clock and turn to your side as soon as you’re cleared.

• Aim for side-lying, belly-forward, pelvis-open positions.

• Ask for a peanut ball between your knees/ankles to help the baby rotate.

• After some rest, you may want to experiment with upright poses

• Change positions at least every hour. Set a timer if that helps.

• Feel a spike of pain on one side? That can be gravity-related “breakthrough” pain, switch sides and let your nurse know.

You can move with an epidural but it can be wise to have some assistance.  Ring for help any time you want to change positions so that the staff can make sure your catheters and monitors are all still in ideal places.  

Understanding Your Medication

• Continuous dose: The epidural runs continuously, or more accurately, on a regular, timed dose.   This baseline may or may not fully control your pain.

• Your button (PCEA): You’ll likely have a button to give yourself extra medication. It is likely to take about 20 minutes to reach full effectiveness.  If pressing it regularly doesn’t help enough, call anesthesia back. They may give a stronger dose through the catheter (often called a “top-off”).

Bladder Care (Catheter)

You probably won’t feel the urge to urinate with an epidural, so a bladder catheter is typically placed to keep your bladder empty. If your epidural is working, this should not hurt. Tell your nurse if you’re uncomfortable before placement so you can wait until you are well numb for this brief procedure.   

All the Cords—And Why You Can Still Move

You’ll likely have:

• Belly monitors

• A blood-pressure cuff

• The epidural catheter

• A bladder catheter

• A pulse oximeter

They can feel like a lot, but they don’t mean you must stay still. Follow your body’s cues and ask your nurse to help manage the lines while you turn.

Pressure vs. Pain (and Why Pressure Helps)

Epidurals typically remove pain but leave pressure especially as your baby descends. Many people feel a strong bowel-movement urge when it’s time to push. That’s useful feedback and often means your body is ready. You may feel this more strongly in one position than another.  Ask for what you need to remain connected to your body.  

Pushing with an Epidural

You can push effectively even if your legs are numb.   Do not get too concerned if the medication has pooled in your legs and they are heavy.  

• Positions on the bed: side-lying with good leg support, supported semi-reclined, hands-and-knees (with help), or upright using a squat bar.

• Ask for position changes during pushing to keep progress going.

• If you feel more during this stage, use that sensation to aim your bearing-down: long, steady, consistent pushes can bring relief during contractions.

Should I Keep Using the Button While Pushing?

There are different approaches:

• Many teams encourage pausing the button when it’s time to push so you can feel your urges and coordinate more effective pushes.

• If pain is so strong that it blocks your focus, more medication may be the better path. 

• You decide what you need, talk it through with your nurse and anesthesia.

Gentle Reminders

• Ask early, ask often: If comfort slips, don’t wait—page your nurse or anesthesia team.

• Rotate positions regularly: Side-to-side with a peanut ball can make a big difference.

• Protect your energy: Rest now so you’re ready for a powerful, effective pushing phase.

Want to go Deeper? 

Check out my LABOR TOOLS downloadable guide.

Worried you won't know what to do when labor starts?

 This guide includes:

• Playbook for contractions

• Making the most of your epidural

• Advice for birth partners

• Tips for raising oxytocin

So you can be supported when the big day comes.

This guide is educational and not a substitute for personalized medical care. Always follow your clinical team’s instructions and your hospital’s protocols (disclaimer)

Optimal Fetal Positioning (OFP): Simple Ways to Make Birth Easier

Looking for something to make your birth easier? Uh, yes please.

Let’s dive into Optimal Fetal Positioning (OFP) and what you can do to encourage it. No matter where you are in pregnancy, you can start now and set yourself up for a smoother birth.

Many people know we want baby head-down by the end of pregnancy. What’s less talked about is which way baby is facing once they’re head-down, and how that can influence when labor starts and how efficient it is.

For most babies, the most birth-friendly position is facing your back, with their spine toward your belly slightly left of center. You’ll often feel those pokey kicks under your right ribs. Ideally, their little chin is tucked, too.

For a deeper dive into all the positions, see Spinning Babies®. In this post, we’ll focus on simple steps you can start now to encourage OFP.

OFP is about helping baby settle into a birth-friendly position before labor begins. That’s more likely when your body is well aligned and relaxed. I start paying close attention to baby’s exact position around 35–36 weeks, but there’s plenty you can do right now to make things easier later.

The Sitting Shift (your easiest win)

Many of us sit a lot and slouching can be tough on the pregnant pelvis and pelvic floor. Your goal is to mimic the upright alignment you’d use while standing, even when you’re seated.

When standing, your pelvis tips slightly forward, there’s a gentle inward curve in your lower back, and your chest is lightly lifted. When you sit, notice how the pelvis tends to tuck or recline and the chest collapses. Reducing time in that reclined/tucked position is the aim.

Guidelines:

• Choose setups where hips are slightly higher than knees.

• Favor a slight forward belly tilt over leaning back.

• Don’t chase perfection, mix positions throughout the day.

• When you’re done for the day, skip the deep couch slouch and try comfy side-lying instead of a big recline.

Try this:

• Birth ball (properly inflated): Let your pelvis tip slightly forward and aim for hips just higher than knees. Balls often stretch; refill over the first couple of days to find the right height.

• Cross-legged with a small cushion: Place it under your sit bones to lift the hips so the belly can tip slightly forward.

• At a chair or desk: Sit forward and lean onto the desk/table rather than reclining. Or turn the chair backward, straddle it, and lean on the backrest. A slouch forward is better than reclining backward.

• Evenings: Choose side-lying over a deep, soft couch recline.

Bottom line: No need to be perfect. Keep “belly forward” top of mind and rotate positions through the day.

Bodywork helps balance

If you have (or have had) hip, pelvis, tailbone, or low-back pain, consider physical therapy or trusted bodywork. When possible, find a practitioner experienced in prenatal care. A relaxed, balanced body gives baby more room to find their best path.

When to start

Begin gentle posture awareness anytime without adding stress. Just notice, and make some changes some of the time. The more consistently you support yourself with simple tools (birth ball, the right cushions, an appropriate chair), the easier upright sitting should feel. Consistency beats intensity.

Want to go deeper?

Check out my downloadable guide, For Right Now, in your pregnancy.

This guide is for you if you want:

• Tools for improving your sleep

• Tips for addressing pregnancy discomforts

• Guidance on raising oxytocin

• Advice on starting now towards a simpler labor

From birth balls to epsom salt baths and sleeping positions, this guide is designed to make pregnant life a little, or a lot, easier.

Any time, but especially by about 35 weeks, check out the OFP education and daily comfort ideas from Spinning Babies®, fantastic resources for staying comfy and encouraging great positioning.

Friendly reminder: This information is educational and not a substitute for personalized medical advice. Always follow your provider’s guidance (disclaimer)