How to Push During Labor?

You’re 10 centimeters!

Ahhhh Those magical words! You are so close to meeting you baby now as your body starts to nudge your baby downward and into your arms. For me it was the best part of labor. There’s not much you can do to ‘make’ yourself dilate…other than keep adrenaline low and mobilize but oh that pushing stage….when you get that irresistible urge to bare down and it feels so productive (and usually painless too – just lots and lots of intense pressure). You probably have lots of questions about how to push and how it all happens.

There are generally three different approaches to the 2nd stage of labor (the pushing stage).

Staff directed (coached pushing) – more common with an epidural.
Mom led pushing – you follow your body’s urges and push when it feels right for you with or without making sounds.
Mom led breathing your baby out – resisting the natural urge to push (traditional HypnoBirthing - Mongan Method).

So here’s the three different approaches – each have pros and cons. One approach might work great for you or you might change your mind during the pushing stage – see what makes sense on the day depending on what’s happening in your labor. When you’re pushing - you might want to request that your provider keeps their curious fingers OUT of your vagina.

How Long Does it Take to Push a Baby Out?

That depends on how low/high your baby is in the pelvis. There is in fact two stages to the 2nd stage of labor. A ‘passive’ stage where you have no strong urge yet and your body is starting to move your baby down and an ‘active’ phase where you just HAVE to push. It can take a few moments to several hours depending on what’s happening in your labor - whether it’s your first baby or not, if you have an epidural and the position of your baby.

Staff Directed Coached Pushing

This is more likely with an epidural where staff instruct you to put your chin on your chest, pull your knees back, curl around your baby and push into your bum to the chorus of . “keep it coming, keep it coming…..”

Pros of Staff Directed Coached Pushing

Staff guide you and tell you when to push and when to stop.

Cons of Staff Directed Coached Pushing

Potentially more tiring for you and baby depending on the station your baby is at (read more here).
Reduced oxygen to mom and baby.
Impact on cardiac output and blood pressure.
Bloodshot eyes and broking capillaries in your face.
Potentially more perineal damage as you can’t feel your perineum.
If an urgent cesarean became necessary with intubation - it can take longer due to swelling in the throat due to long periods of coached pushing.

How on Earth did Babies Manage to Get Out Without Assistance?

Giving birth in hospital is quite a recent phenomena so how on earth did babies manage to get out without a nurse/midwife/OB telling you to push? Simple – your body and baby do a LOT of the work really well without the need for any outside influence.

I attended a birth several years ago where mom had an epidural and was 10cm – for ……10 hours….yes that’s considered a very long 2nd stage. At the beginning of that 10 hour period baby was still very high in the pelvis and after an hour of coached pushing baby seemed to not like that approach – so an incredible OB suggested mom relax and labor down (see article) for a bit. Coming up on 10 hrs the OB came back to discuss what the parents options were…but offered to do a vaginal exam to see how close baby was….and to everyone’s surprise baby was almost on the perineum..mom pretty much coughed her baby’s head out. I’m not suggesting you ask for 10 hours but sometimes with an epidural this stage can take longer so why not rest and let your body push for you.

Ironically research suggests that staff directed pushing is associated with longer pushing time, more babies admitted to NICU and more episiotomies.

Mother Led Pushing (Spontaneous Pushing)

Staff offer supportive words as you go with those irresistible urges to push. You push only when it feels right to do so. Just like nobody needs to tell you when you need to have a bowel movement (the signals from your body tell you) – when you need to push you don’t just think you want to push you can’t NOT push…you neeeeeeeeeeeeeeed to push and you can’t stop yourself.

Pros of Mother Led Pushing

Less tiring for you and baby.
You are in the drivers seat following your body’s lead.
Staff are there to support and encourage you quietly.
Lots of oxygenated blood to baby, uterus and perineum (allows perineum to stretch gradually).
Potentially reduced perineal injury, swelling and hemorrhoids

Cons of Mother Led Pushing

If you’ve a Type A personality you may be anxious about getting pushing ‘right’ and prefer a more directed approach.

Mother Led - Breathing Your Baby Down

Pros of Mother Led - Breathing Your Baby Down

You run the show
Staff let you get on with it with quiet encouragement
Potentially reduced perineal injury, swelling and hemorrhoids

Cons of Mother Led - Breathing Your Baby Down

Needs a lot of focus and control to not follow those irresistible urges to push.
Not all staff are supportive of this approach and can increase anxiety in the birth room.
Some moms feel they didn’t do it ‘right’ if they go with their urges to push.

Mongan Method hypnobirthing classes focus on this approach where you simply let your breath nudge baby down and ignore your body’s overwhelming urge to go with your body. When your body starts pushing there’s no stopping it – and sometimes trying NOT to push can be really distressing especially if staff are asking you to stop pushing as you’re not quite 10cm (read more here).

According to the Founder of HypnoBirthing the irresistible urge to push is due to cultural conditioning rather than biology.

“Often women speak of an overwhelming urge to push taking over. If this is felt it is also because of conditioning… our animal sisters elect to gently expel their babies” (Mongan 2005, p.129)

Honestly I think this sets moms up to believe they didn’t do it right if they didn’t dreamily breathe their baby out and roar their baby out instead - I think we have enough mom guilt already – don’t you?

Benefits of a Mother Led Pushing Stage

The benefit is a more GentleBirth for your baby - picture this…imagine putting your hand into the sleeve of a new jacket with a satin lining. Approach 1 - staff led pushing involves moving your hand into the sleeve forcefully – what usually happens is the lining gets pulled out at the end of the sleeve. With forceful pushing just like that sleeve lining can potentially drag on your pelvic organs. With a mother led approach your hand moves through the lining more slowly and carefully so as to not disrupt the ‘lining’. Also remember that there are plates in your baby’s skull that overlap coming through the pelvis protecting your baby’s brain. Obviously we want those plates gently expanding as your baby’s head emerges instead of rushed.

You have more energy to meet your baby and your perineum is usually less ‘traumatized’. I find there is often quite a difference between the vulval tissues of a mom who has been coached pushing for hours and a mom who has gone with her own urges – in my experience there’s a lot less swelling and generally less tearing.

5 Steps to a Positive Pushing Stage of Labor

1 - Practice when you poop.

Next time you need to have a bowel movement try to wait a little bit until you really really need to go. Notice what happens. It’s usually a more ‘efficient’ pooping experience. Now imagine I told you to go have a bowel movement right now – unless you are feeling the urge you’ll just sit there….strain a lot, possibly give yourself a hemorrhoid and wear yourself out (you might poop a bit too). Telling a mom to push when she has no urge is just like telling someone to poop without feeling the urge to go. Similarly telling a mom to stop pushing is like me telling you to stop digesting your lunch for the next 60 seconds….you can’t – it’s completely out of your control.

Slip n Slide or a Bumpy Ride

Did you know that during a surge the inner walls of the vagina smoothen out and make baby’s path more like a slip n’ slide.

Pushing without that surge - is more like this… (I’ll take the slip n’ slide any day!)

2 - Talk to Your Careprovider

Chat about their approach to the pushing stage – hopefully you’re both on the same page. Have written birth preferences and have your birth partner facilitate for you. Keep your approach flexible but if all is well there’s no reason why you can’t have a very positive empowering pushing stage too. Don’t forget to talk to your provider about how they will protect those tissues as you push as well as what their normal practice is after your baby’s head is born - pull on it - or wait a moment? (Waiting - not pulling is recommended but that’s not how US Obstetricians are taught).

3 - Let the Pressure Build

Allow the pressure of the surge to build until it’s irresistible and you just can’t not push. Your body is pushing with or without you. It can help to imagine you have a nose on your bump to remind you to send your breath all the way down to your baby.

4 - Write epidural birth preferences to labor down.

5 – Grunt, moan, swear or don’t - do what works for you.

Download the GentleBirth app to help prepare you for a positive pushing stage with or without an epidural (listen to Learning How to Push and Imagery for Pushing today).

Click here for Android.

What approach worked best for you?

Push Your Baby Out or Breathe Your Baby Out - 5 Steps to Positive Pushing