Pushing With and Epidural: Station vs Dilation

Pushing with an Epidural: Station Over Dilation

So you’re 10cm dilated, exciting! Time to start pushing? Not necessarily. Did you know that pushing too early is associated with some risks? We’re here to break it down for you. 

Whether getting an epidural is part of your birth plan or not, knowing when to push (and when not to push) is a topic we cannot emphasize enough! While it is true that your body will innately know when and how to birth your baby, getting an epidural can interfere with your natural ability to feel labor sensations, meaning you may not experience the typical “urges” of how and when to push. This is why we doulas love to take time prior to birth to educate birthing individuals on knowing the difference between “you can push” and “it’s optimal timing to push”. 

Disclaimer: this article is written from personal doula experience and education and not medical expertise. Each birth looks and progresses in its own unique manner. This is not medical advice, but rather general information from your trusted doulas! We encourage you to take it into consideration and continue the education and conversation with multiple sources including your medical provider :)

Let's dive in! So you've heard of the term dilation, great, but did you know there are other factors that determine when the best time to start pushing is? 

There are 5 variables  that medical personnel take into account when determining how “far along” a birthing body is into labor (this is called a Bishop’s Score and if you want to nerd out and learn more you can check out this YouTube video that breaks it down). Your medical provider will access these variable through a cervical exam and the main three to know more about are: 

1. Dilation (the opening of your cervix, measured in centimeters)
2. Effacement (the thinning of your cervix, measured in percentage)
3. Station (the location of your baby in your pelvis, more details below) 

During hospital births where an epidural is in place, there tends to be a heightened focus on the dilation of your cervix. In fact, when the cervix reaches 100% effacement and 10cm, your nurse may say “your are complete!”, followed by an invitation to begin pushing. So what's the issue? 

Well, after several hours (and potentially multiple days) of laboring, hearing you can push may sound enticing, however, this does not necessarily mean it's the optimal time to begin pushing. What matters is the combination of all three factors - effacement, dilation, and most important, station. 

What does “station” even mean?

The graphic below offers a visual of the stations your baby will move through. There are 3 main levels:

1. Inlet (station -3 to -1)
2. Midpelvis (station 0)
3. Outlet (station +1 and beyond).

In early labor, your baby is likely very high in your pelvis (station -3 or higher). As you labor, your baby is making their journey lower and lower, until they are fully engaged in your pelvis at station 0.This is the point at which your baby’s head is even with your ischial spines. It is at station 0 that medical personnel will likely invite you to begin pushing (if you are 100% effaced and 10cm dilated). By now, you have made fantastic progress and are very close to meeting your baby - however there is a bit more work to do. 

The purpose of this blog is meant to encourage a pause in that moment right there! You CAN start pushing, but is it truly the best thing for your body and your baby (despite how eager you may be to start pushing)? 

Let's highlight what we consider the optimal time to start pushing and some of the reasons why you may benefit from waiting just a bit longer. 

Optimal time to push

In a low risk/low complications birth, pushing will ideally begin when your baby reaches the outlet at station +1, even better, waiting until station +2 (characterized by the feeling of increased rectal pressure). You can work with your body and your baby to make your pushing journey shorter and more effective. Once fully dilated, a birthing  body undergoes a psychological resting stage in which the body and baby store up energy for pushing. This stage is important and is often disregarded. During this stage contractions may increase in intensity but decrease in frequency. 

Delayed pushing, also known as “laboring down”, allows your body to rest and move your baby down the birthing canal without pushing during contractions. This allows you to push only when rectal pressure builds giving your body and baby a fighting chance at a vaginal birth with fewer interventions and/or complications. 

What is the harm of pushing too early/too long?

• Maternal exhaustion
• Higher chance of operative interventions 
• Greater risk of perineal tearing 
• Uterine atony (uterine fatigue) 
• Hemorrhaging 

Bottom line, pushing too early can lead to what we refer to as prolonged pushing. If your body and baby are not ready for the pushing stage, you run the risk of pushing for an extended period of time (on average 2-6 hours!), which increases the risk of energetic depletion, instrumental interventions, and postpartum complications. 

Just because prolonged pushing has been normalized, it does not mean it has to be part of your story. We encourage you to give yourself permission to do things differently! 

So how do I avoid pushing too early? 

• Specify on your birth plan/birth preferences that you wish to labor down to station +2. (it is your right to determine how and when you push despite any other voices in your birthing space)
• Have your doula or birthing partner remind medical personnel that you prefer to wait (if there are no complications). Make it known that you are aware and have clear preferences. 
• Inquire about the station of your baby with every cervical exam (this is a fun task for your birthing partner - if you have one - to be in charge of asking what station your baby is at!)
• Wait until you feel increased rectal pressure.
• Integrate spinning babies practices (find a doula who can support you in this!)
• Connect with your body and baby. Trust. It’s worth the wait.

The good news: even with an epidural there are many positions you can integrate into your labor to optimize space in your pelvis and to help encourage your baby to move into this space. For more information check out spinning babies practices: https://www.spinningbabies.com/optimal-maternal-postions-at-the-levels-of-the-pelvis/#:~:text=0%20station%20is%20in%20the,at%20the%20inlet%20or%20%2D3.

Are you interested to learn more about how a doula can support you during your labor? You can book a free consultation with Doulas of North County to learn more.