You’ve learned all you can about pregnancy, the signs of labor, the stages of labor, and how to cope with labor pain. And you know, of course, that you’ll need to push the baby out. But what do you know about that part? Let’s discuss the specifics, including when to push, what positions you may find most effective, how long it might take, and exactly how to push during labor.
Estimated reading time: 8 minutes
Table of contents
- How Will I Know When to Push During Labor?
- What Are the Best Positions for Pushing During Labor?
- How Exactly Do I Push?
- How Long Does Pushing Take?
- Is Pushing Different with an Epidural?
How Will I Know When to Push During Labor?
There are actually two schools of thought about when a woman should push. In the last century, it has been standard practice for a woman to be given the green light to push as soon as her cervix is dilated to 10 centimeters. She may not yet feel a strong urge to push, but is told to push with each contraction. With this method, the mother pushes the baby all the way down, through the birth canal and out.
However, there is a good deal of evidence that it’s beneficial to allow the woman to wait until she feels a strong urge to push (1), and more doctors and midwives are following that advice. The urge to push does not usually come as soon as the cervix hits 10 centimeters. In most cases, there’s a latent phase, or a waiting period, after mom is 10 centimeters dilated and before she feels the need to push.
What happens during this latent phase? Your body begins to bring your baby down into the birth canal and rotate him into position. (That’s why this process is called “laboring down.”) In other words, when you do begin to push, you’re only pushing the baby out rather than pushing him all the way down and out. Why waste energy doing work that your body will do on its own if you just wait?
When It’s Time, Your Body Will Tell You
If you choose to labor down and wait for your body to tell you that it’s time, it’s often an unmistakable urge. You will feel tremendous pressure in your bottom (think bowel movement), and your body will begin pushing or bearing down without your conscious decision to do so. You will simply be advised to push along with your contractions when it feels right to do so. In fact, it can actually be hard to refrain from pushing if your doctor or midwife asks you to hold off. (Sometimes caregivers will try to help slow things down if baby is descending quickly, because giving your perineum more time to stretch can lessen tearing.)
What Are the Best Positions for Pushing During Labor?
Lying flat on your back is actually one of the worst positions for pushing (or any part of labor, really). This position didn’t become popular until about the seventeenth century, and seemingly because it’s the most convenient for the caregiver who is attending the birth. It works against gravity, and it also puts the most pressure on the perineum, risking more tears and episiotomies (2).
Upright positions take advantage of gravity in helping bring baby down, and through most of history, women are shown giving birth in an upright position – squatting, using a birthing chair, kneeling, or even standing. Squatting may be the most effective birthing position (3), as it widens the pelvis and also uses gravity to help baby descend, but it can increase your risk for perineal tears if baby is descending quickly. And it’s also a tiring position to hold for very long. A birthing stool or chair, if available, is a good way to hold a similar position without so much effort. You may also choose to alternate squatting with other positions, such as kneeling, lying on your side, or resting semi-reclined.
How Exactly Do I Push?
Before giving advice on how to push, I’d like to say that it’s important to listen to your body. It’s great to know as much as possible about childbirth in advance, but when the time comes, you add that incredibly important additional factor — what your body is telling you. A certain position may be the one that feels right to you. You may feel your body beginning to push on its own and just need to follow its lead. However, not everyone feels a strong intuition to do things a certain way, and that’s why it’s helpful to have some knowledge up front about how to push effectively.
Tips for pushing during labor
- Position – Get into the position that feels best. You can change positions as you discover what feels best and what seems to be most productive.
- Push – In short, pushing a baby out uses the same muscles as does pushing stool out. During a contraction, you will bear down and push as if you were having a bowel movement. (More on this below.)
- Focus your pushes – Try not to tense up your whole body. Relax your neck and shoulders, your thighs, and (although this sounds really difficult) your pelvic floor. Focus on pushing with your abdominal muscles.
- Breathe – You don’t have to push to the count of ten. When women follow their bodies, most push for five or six seconds at a time, and may do that several times during a contraction. Not holding your breath for too long (as with a ten count) ensures that you and baby have plenty of oxygen.
- Rest – Do your best to relax, rest, and breathe between contractions. The pushing stage may take a while, and you should conserve your energy the best you can.
- Stop if instructed – If your doctor or midwife asks you to stop pushing, try to relax and breathe. It can actually be hard not to bear down when you feel the urge to do so, but your caregiver may want you to rest for a contraction or may be trying to protect your perineum by slowing down baby’s exit.
Will I Poop When I’m Pushing During Labor?
So many women worry about this. Will you poop during labor? Possibly, but not necessarily. Between your abdominal muscles squeezing and your baby’s head pushing hard against the rectum that runs right beside the birth canal, pooping in labor can happen. While it may feel like a huge deal to you, it is nothing to your birth workers. They simply wipe it away and keep going. In fact, some caregivers say that they’re happy when they see it because it means that you’re pushing the right way.
But not everyone poops during pushing. Many women have diarrhea in early labor, and therefore have their bowels cleaned out before the pushing phase.
How Long Does Pushing Take?
Many moms wonder how long to expect the pushing stage of labor to take. While actual time varies widely, the average is one to three hours for a first-time mom and less time for a mom who has given birth before.
Learn More: How Long Does it Take for a Natural Birth?
Is Pushing Different with an Epidural?
All the above information is good to know and mostly still applies to you if you decide to get an epidural. However, getting an epidural means that your lower body is mostly numb. That is, of course, how it helps block the pain. But a side effect of blocking the things you don’t want to feel is that you may also block some of what you do want to feel. This affects you in a couple of ways:
- Knowing when to push – You may still have a pretty good sense of at least the pressure from contractions and baby’s descent with a light epidural. If so, you can time your pushing to match that sensation of pressure. But there’s a chance that you won’t really be able to tell when to push or if you’re doing so effectively. In this case, you’ll rely on your doctor, midwife, and/or nursing staff to let you know when you’re having a contraction and when to push.
- Pushing position – An epidural means that you’ll have to stay in bed, because your legs aren’t strong and steady enough to bear your weight and keep you safe. But this doesn’t mean you’ll have to be stuck lying flat on your back, though. Try a side-lying position, or raise the head of the bed so that you can push in a semi-seated position. Pro tip: Place a peanut ball between your legs to open your hips and support the weight of your legs while pushing.
While pushing in labor can seem a mammoth effort, it’s exhilarating to know that it’s the final step before you welcome your baby into your arms. Trust your body, your intuition, and your health care team and you are sure to have a successful pushing experience. Good luck, mama!
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- Simpson K. R. (2006). When and how to push: providing the most current information about second-stage labor to women during childbirth education. The Journal of perinatal education, 15(4), 6–9. https://doi.org/10.1624/105812406X151367
- Rodrigues, S., Silva, P., Agius, A., Rocha, F., Castanheira, R., Gross, M., & Calleja-Agius, J. (2019). Intact Perineum: What are the Predictive Factors in Spontaneous Vaginal Birth?. Materia socio-medica, 31(1), 25–30. https://doi.org/10.5455/msm.2019.31.25-30
- DiFranco, J. T., & Curl, M. (2014). Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body’s Urge to Push. The Journal of perinatal education, 23(4), 207–210. https://doi.org/10.1891/1058-1243.23.4.207