How to Push During Labor
Of course, it’s entirely possible to have a successful labor and delivery if you just wing it. But it’s best to be prepared and know what to expect during labor to minimize pain and help prevent complications. If you’re planning on giving birth to baby through a vaginal delivery, learning how to push during labor is important—before you enter the delivery room. We spoke with experts on how to breathe while pushing, how to minimize tearing during delivery and more.
Pushing, which is the second stage of labor, can take 30 minutes (ideal) or it can take several hours (not so ideal). The timeline can vary depending on several different factors, says Rebecca Keith, MD, an ob-gyn at Pediatrix Medical Group:
- Fetal size. Babies who weigh more and are larger can be harder to push out and may take more time, says Keith.
- Fetal position. The optimal position for vaginal delivery is when baby is head down. However, if baby’s face-up or coming down at an angle, that can increase pushing time.
- Mom’s size and age. “The size and shape of the woman’s pelvis can affect pushing times,” Keith says, noting that if the pelvis is too small, baby’s head may not be able to come down. Women over 35 tend to take longer to push, she adds.
- How many times Mom has given birth. First-time moms and parents-to-be usually push longer than those who’ve had previous vaginal deliveries, she says.
- Whether you got an epidural. An epidural can sometimes prolong pushing time, Keith says. “But other times, I’ve seen an epidural allow a mom to relax, focus and push more effectively, thus shortening the pushing phase,” she adds.
Research typically defines a prolonged second stage as more than three hours of pushing for a first-time delivery and more than two hours of pushing if you’ve previously given birth.
Pushing baby out can sound intimidating. But learning all about what’s happening and focusing on your birth plan can make a big difference.
As you start to feel contractions, your cervix will start to dilate, directing baby’s head into your pelvis, explains Keith. You can start pushing once you’re completely dilated and baby’s head’s at a certain point in the pelvis.
Below, the basic steps behind how to push during labor:
- Start with a cleansing breath as your contraction starts and blow that out.
- Take a deep breath, “curl around your baby and bear down,” says Cynthia Banks, CNM, MSN, RN, a nurse-midwife at Millie Clinic in Berkeley, California. “You use the same muscles as when having a bowel movement… Your push will be most effective if you keep your breath in to add force.” Keith adds that your doctor or nurse will typically count to 10 as you push, aiming for three pushes during each contraction; four if Mom has the strength and contractions are lasting longer.
- Breathe out after approximately 10 seconds. “It’s important that mothers don’t let their air out while pushing,” Keith warns. “Doing so decreases the downward push into the pelvis.”
- Repeat steps two and three for the duration of your contraction, aiming for three or four good, strong pushing efforts with each contraction. “You might try reaching down to hold behind your thighs or to hold your lower legs and pull,” Banks says. “This helps you put some upper-body strength into it.” She also strongly recommends changing positions every 30 minutes or so.
There are several different positions you can get into when pushing. If you don’t have an epidural, you can squat, says Keith, adding that most delivery beds have moving parts or will “break down” to help get you into these positions.
Between contractions, Keith notes that it’s important to try to rest to save up your energy for the next push.
How to push during labor with an epidural
Because epidurals significantly decrease your pelvic sensation, it can take longer to figure out how to push effectively, Banks says. She recommends having your nurse or midwife give you feedback or coach you during pushes so you can get a better idea of how to move baby down. Your nurse, midwife or doctor can check for signs of baby’s head descending to keep you updated on what’s going on. “Often, as your baby descends, you’ll start to feel more sensation again, even if your epidural has kept you very comfortable up to this point,” Banks says. “It might feel like a deep ache in your hips or you may feel rectal pressure. Use that sensation to guide you. Push into it.”
Are there ways to push during labor without tearing?
It’s not uncommon to tear during labor. “Minor tearing is a natural part of having a vaginal delivery and will occur in greater than 70 percent of first-time mothers,” says Greg Marchand, MD, FACS, FICS, FACOG, an ob-gyn and expert in minimally invasive gynecologic surgery. But while there’s no foolproof method to prevent tearing, a few tips can help to minimize it:
- Slow down as baby starts to crown. Banks notes that baby crowning is “the time of maximum stretching of your perineum” so that baby’s head can make it through. She recommends moms make shorter, smaller pushes during crowning to help reduce tearing.
- Try perineal stretching during the last few weeks of pregnancy. At around 35 or 36 weeks, you can try stretching your perineum about two or three times a week, Banks says. “Practice relaxing all your pelvic floor muscles, especially when the stretch feels a bit intense,” she says. “That way, when you feel those same sensations during pushing, you may feel more relaxed and less likely to tense up the muscles, which need to soften and release.”
- Try a perineal massage. Perineal massage has shown to be effective in minimizing tears, says Keith. While some women will have their partners do this during the last few weeks of pregnancy, Keith says she also performs it during delivery while her patients are pushing.
Pushing baby out often feels like having a big bowel movement. It can feel like a lot of pressure on the vaginal and rectal area, Keith notes, and Banks adds that “it can actually feel good to push, like a relief.”
Pushing is also often described as painful (no surprise there). “Pushing was probably the hardest thing I’ve ever had to do,” says Christina W., a mom of two from New York. She explains that with her first delivery, her epidural didn’t numb her completely, and she was in so much discomfort she didn’t know how she’d push baby out. With her second baby, the epidural seemed more effective, and pushing was easier and faster. “They let me feel her head as she was crowning and it gave me the motivation to push her out, and it felt more natural and easier,” she says.
Without an epidural, pushing can feel more intense. “My epidural failed and because I was induced the contractions were really intense,” says Chrissy A., a mom of one in New York. “I just went with what my body was telling me and used every piece of energy I had to get him out.” She notes that while the pain left her feeling a little out of control, she also felt “immediate relief” when baby was safely delivered—“like the entire day never happened.”
For Samantha B., a mom of two from Colorado, pushing during her first delivery took about three hours. “I felt fatigued very quickly and felt very hot,” she says. “I just felt like I was exerting a lot of energy, but I didn’t feel the baby lowering or anything. It wasn’t until her head reached the birth canal that I could feel her exiting my body.” With her second baby, the need to push and relieve the pressure of the contractions was intense and a more effective epidural that time around made things easier. She also noted that the nurses moved her into different positions the second time around, saying, “This helped so much.”
How you breathe while pushing matters: It can either help relieve pressure or make things more uncomfortable. Both Banks and Keith suggest a technique called closed-glottis pushing, which involves taking a deep breath and holding it for 10 seconds at a time while pushing down. “I’ll count to 10 while [a mom-to-be] is pushing. At the count of 10, she exhales that breath and immediately takes another deep breath,” Keith explains. “We then push again for a count of 10.” Both experts recommend pushing three times with each contraction, or four times if contractions are lasting longer and you have the strength. Keith also notes that moms shouldn’t let air out while pushing, as this can decrease the downward push into the pelvis.
Another technique is known as open-glottis pushing, which is the opposite: Instead of holding your breath for 10 seconds, you exhale while pushing. “This may be attainable if you’ve had a vaginal birth before,” Banks says. “However, if this is your first time pushing out a baby, you’ll likely need to rally the strength of your diaphragm for maximum pushing effort.” One study didn’t find a difference in effectiveness between both techniques—so pick what works for you.
Pushing during labor can feel chaotic, intense and like a bit of a blur. “Your body will be working hard,” Marchand says. “You’ll be sweating, and if you have an epidural you’ll notice shivers, as your body tries to adjust for the parts of your body that it can’t feel.” You’ll be experiencing uterine contractions and may have trouble getting comfortable.
Meanwhile, the medical team around you will be hard at work supporting you. Keith notes that the nurses, midwives and doctors will often support your back, legs or both to help you push more efficiently. To make you more comfortable, they may provide cool cloths or sips of water or ice. They’ll also be closely monitoring your vital signs and those of baby, Banks says.
Delayed pushing, also known as laboring down, means waiting for a while after you’ve completely dilated to start pushing, says Marchand. “The idea is that instead of immediately beginning to push, if the mother has a working epidural you can instead allow her to relax for up to two hours,” he says. “While she’s relaxing, her uterus will contract and may do much of the work of pushing out the baby for her, even though she’s simply comfortably relaxing.”
“This used to be common practice when the laboring person has an epidural,” Banks says. “It’s less likely to be utilized now since evidence tells us that the practice is associated with more complications.” She says that unless you’re exhausted and really need a break before pushing, you’ll likely be encouraged to start pushing as soon as you’re fully dilated.
That said, Marchand says delayed pushing can help in some cases. “It can allow a woman to deliver vaginally who otherwise may have needed a cesarean section because of a baby that couldn’t tolerate pushing,” he says.
In most cases, you’ll be asked to push out the placenta after baby’s born. After delivery, the uterus will usually continue to contract so that the placenta comes out as well, explains Keith. “There are signs that the provider can recognize when the placenta has started to release from the uterine wall,” she says. “When this happens, we’ll have the mom resume pushing to assist in the delivery of the placenta.”
More pushing after pushing baby out? It’s not as bad as it sounds, promise both Keith and Banks. It typically takes less than 30 minutes and doesn’t require as much effort. “The placenta is soft, squishy and much smaller than baby,” Banks says. “You may not even feel much at all when it comes out.”
Once baby has entered the chat, the hardest part is over. Banks explains that as soon as baby’s out, they’ll be placed on your abdomen, dried off and monitored. “Some people describe feeling a huge rush of joy, euphoria and relief,” Banks says. “There’s an immediate reduction of pain.”
Physically, your body works on repairing itself during post-birth recovery. “The uterus starts trying to clean itself out by bleeding,” Marchand says. “This is called ‘lochia’ and is a normal part of delivery.” He notes that your vulva will likely swell up following delivery.
After your placenta comes out, you may need to receive stitches. Throughout it all, you’ll most likely be encouraged to stay skin-to-skin with baby, says Banks.
Pushing during labor can be a painful and exhausting experience—but the end result is more than worth the effort. And if you educate yourself on how to push during labor, your labor and delivery will go that much smoother.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
Plus, more from The Bump:
Cynthia Banks, CNM, MSN, RN, is a nurse-midwife at Millie Clinic in Berkeley, California. She received her Master’s degree in Nursing and Midwifery from the Yale University School of Nursing.
Rebecca Keith, MD, is an ob-gyn at Pediatrix Medical Group. She earned her medical degree from Indiana University School of Medicine.
Greg Marchand, MD, FACS, FICS, FACOG, is an ob-gyn and expert in minimally invasive gynecologic surgery, as well as the founder of the Marchand Institute for Minimally Invasive Surgery in Arizona. He leads the Society of Laparoscopic and Robotic Surgeons-accredited fellowship at Steward Health. He earned his medical degree from Spartan Health Sciences University in St. Lucia.
American Journal of Obstetrics & Gynecology, The Second Stage of Labor, March 2024
American Journal of Obstetrics & Gynecology, Closed- or Open-Glottis Pushing for Vaginal Delivery: A Planned Secondary Analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage After Vaginal Delivery Study, March 2024
Midwifery, Is Directed Open-Glottis Pushing More Effective Than Directed Closed-Glottis Pushing During the Second Stage of Labor? A Pragmatic Randomized Trial - the EOLE Study, December 2020
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