When most of us think about pushing in labor, our minds run to images we’ve seen in movies. Mom holding her breath and bearing down, red-faced, while the people around her tell her to push. But does it always look like that? Does it need to be such an intense strain, and does it have to be doctor-directed? Let’s learn about the pushing stage and explore the idea of natural birth without active pushing.
Estimated reading time: 11 minutes
Have you ever watched a nature documentary where an animal gave birth, or been able to witness it live and in person? They don’t need anyone to tell them what to do. No one needs to tell them that it’s time to push or how to do so or for how long. Their natural births don’t seem to require spending hours on active pushing. And yet, the baby is born. (You never hear of a horse that had to carry her baby until it was an adult because no one was there to tell her when to push it out!)
In some ways, human bodies are more complex than other mammals. But in many ways, we are the same. Our bodies are made to birth babies. We’ve been doing it literally for as long as there have been people. And the incredible design of our bodies means that our bodies know what to do even when we don’t consciously know. Sometimes the best thing we can do is simply trust our own bodies.
The second stage of labor begins when a woman’s cervix has reached a dilation of 10 centimeters and ends when her baby is born (1). In the first stage, her body has been making the changes to get ready for this — thinning the cervix and dilating up to the full ten centimeters. In the third stage, the placenta is delivered. But that important second stage is where the magic of bringing baby into the world happens. This is the stage that people think of as the pushing stage. But it’s really the bringing the baby from the womb to the outside world stage. And while you might think that just means pushing, that’s not necessarily the case.
You’re very likely familiar with the pattern of waiting for the cervix to fully dilate so you can begin pushing. Even if you’ve had a baby before, you may have experienced the steps just like that — you wait until fully dilated and then you’re told you can start pushing. But full dilation does not always produce a strong, irresistible need to push. Sometimes there’s a latent phase where things seem to slow down or stop for a bit after dilation to ten centimeters. In those cases, should doctors tell women to go ahead and push anyway, or is there a benefit to waiting for the body to take over and tell you what to do? Let’s look at the different ways to push during labor, and compare the possibilities.
With directed pushing, your doctor or midwife tells you when and how to push, and typically starts the pushing as soon as you are fully dilated. You may be told to hold your breath, bring your chin to your chest, and push as hard as you can. You’re likely told to hold it for a ten count. This may be repeated several times during each contraction, or you may be encouraged to just push as long and hard as possible throughout the contraction. You may be surrounded by nurses and doctors telling you “push, push, push” and “keep going” and “push into your bottom” and “push as hard as you can.”
This is how labor often looks on TV, and honestly, it often looks this way in real life as well. But what many people think of as “normal” wasn’t the norm until the 1920s when doctors came to believe that a long second stage of labor could be dangerous to the baby if not moved through as quickly as possible (2). Even though we’ve known for many decades that this isn’t true, it is still common for the second stage of labor to be rushed by starting pushing as soon as a woman reaches ten centimeters, rather than waiting for her to feel the urge to push. You may be wondering why it even makes a difference if a woman is told to push or decides to. Read on!
As we’ve said, a woman’s body knows how to give birth. Even if not told to push, a woman will still feel her body begin to do so. Most women experience an irresistible and involuntary need to push when it’s time. Once the time comes, each contraction will probably bring several strong, irresistible urges to bear down, with each of these surges lasting about five to seven seconds (3). Your body will begin to bear down spontaneously, as a reaction to this urge to push, and you can simply follow its cues.
But here’s the big difference between spontaneous and directed pushing — this urge to push does not always come right as the cervix finished dilating. There may be a phase of what is sometimes called “laboring down” before the body is actually ready to push the baby out.
After a woman’s cervix has finished dilating, she may not feel the need to urge for some time, as much as an hour or even two. What is happening during this time? Your body will start to naturally start bring baby down and rotate him or her into position. Instead of starting to push as soon as the cervix is ready — which means having to actively push your baby all the way through the birth canal and out — you let your body do the work of bringing baby down and begin to push after baby’s head has descended. You are able to save your energy for pushing your baby out, rather than needing to push your baby all the way down and out.
So we’ve determined that in the case of natural birth, it’s not necessary (or even necessarily desirable) to deliver with active, coached pushing. But what if you have an epidural? Well, you can talk to your doctor about trying to labor down and push spontaneously, depending on how numb you are, but women with epidurals often don’t have enough sensation to really feel contractions. Directed pushing helps moms know when to push with a contraction, because she may not feel contractions well enough to time her pushing on her own. In fact, the current recommendation from ACOG (The American College of Obstetricians and Gynecologists) is for women who have had an epidural to push at the beginning of the second stage rather than delaying pushing (4).
Directed pushing is sometimes also used if mom doesn’t develop a natural urge to push or isn’t pushing effectively, even when pushing in upright positions where gravity works with you (3). As in the case of an epidural, this allows your doctor to step in and help if needed.
Studies have shown that allowing a mom to labor down and wait until her body is ready to push may be beneficial to both mom and baby.
Communication is key. If you want to try natural birth without active pushing, talk to your doctor or midwife. Learn about how they usually do things and let them know your preferences. An article in The Journal of Perinatal Education includes a wonderful chart that you may choose to include (or use to form your own words) in your birth plan:
Birth Plan Content for Second-Stage Labor
| • Please wait until I feel the urge to push before asking me to push. |
| • Please allow me to do whatever comes naturally when pushing (I may or may not choose to hold my breath). |
| • Please do not count to 10 during each of my pushing efforts. Allow me to bear down and hold it as long as I feel comfortable. |
| • Please let me know how I am doing and offer words of encouragement. |
| • Please allow me to position myself for comfort and help me to change position often. |
| • Please do not push my legs back while I am pushing. Allow me to keep my feet flat on the bed if I choose to push in that position. |
| • Please watch how my baby tolerates pushing and use the fetal heart rate pattern to guide your pushing directions. |
| • Please do not massage or stretch my perineum while I am pushing. Allow my perineum to stretch naturally. |
Perhaps the most important thing to note is that your body knows how to give birth. Thanks to something called the fetal ejection reflex, your body can give birth to your baby even if you’re not conscious. In fact, it sometimes happens even if you’re trying not to deliver yet. Think, for example, of babies born in a car on the way to the hospital when mom very much did not want to deliver. Women often describe a feeling of their bodies taking over during birth and just pushing even though they weren’t trying to.
If the idea of pushing a baby out of your body without a doctor directing your pushes seems foreign, just remember that women gave birth that way for most of our entire history on Earth, and that your body already knows how to do exactly what it needs to do. Trust in yourself and let your body guide you through getting your little here, so you can finally meet him or her face-to-face.
Kopa Birth’s online birthing classes allow you to prepare for a natural hospital birth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class and start preparing for your natural birth!
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Kopa Birth’s online birthing classes allow you to prepare for a natural hospital birth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class and start preparing for your natural birth!
When most of us think about pushing in labor, our minds run to images we’ve seen in movies. Mom holding her breath and bearing down, red-faced, while the people around
