How To Push During Labor? Guide

Pushing during labor is not about straining with all your might. It is about working with your body’s natural urges and using your breath to guide the baby down. Research from the American College of Obstetricians and Gynecologists confirms that following your body’s spontaneous urge to push is just as effective as directed pushing, and often less exhausting.

What Does It Actually Mean to Push During Labor?

Pushing is the second stage of labor. This stage starts when your cervix is fully dilated at 10 centimeters. It ends when your baby is born. For first-time mothers, this stage can last anywhere from 20 minutes to three hours. For women who have given birth before, it is often shorter.

The sensation of needing to push feels like a strong pressure in your lower pelvis. Some women describe it as feeling like they need to have a large bowel movement. This is normal. Your body is telling you it is time to work with the contractions.

There are two main approaches to pushing. Spontaneous or “physiologic” pushing means you push only when your body feels the urge. Directed pushing means a nurse or doctor tells you when to push based on the contraction monitor. A 2017 Cochrane review found that spontaneous pushing leads to shorter pushing times and less need for medical interventions like forceps or vacuum delivery.

How To Push During Labor: The Step-by-Step Process

Step one is positioning. You do not have to lie flat on your back. In fact, research published in the Journal of Perinatal Education shows that upright positions like squatting, kneeling, or using a birthing stool can shorten the pushing stage by an average of 20 minutes. Gravity helps. If you are lying down, ask to sit up as much as possible.

Step two is breathing. When a contraction starts, take a deep breath in. Then hold it briefly and bear down like you are having a difficult bowel movement. Do not hold your breath for longer than six to eight seconds. Prolonged breath-holding can reduce oxygen flow to your baby. Some women prefer to exhale slowly while pushing. Both methods are fine. The key is not to strain.

Step three is resting completely between contractions. This is where most women make a mistake. They continue to brace or tighten their muscles between pushes. Rest is not optional. Your uterus needs oxygen to contract effectively. Between contractions, relax your entire body. Let your jaw go slack. Let your shoulders drop. Let your legs fall open. This recovery time is what allows you to push effectively during the next contraction.

Step four is following your body’s lead. If you feel an overwhelming urge to push, push. If the urge fades mid-contraction, stop pushing. Do not fight your body. Some women have a strong urge from the start. Others feel very little urge until the baby is much lower. Both are normal.

Directed Pushing vs. Spontaneous Pushing: What the Research Shows

Directed pushing became common in hospitals during the 1950s and 1960s. The idea was that it would speed up delivery. But the evidence does not support this.

A 2020 study in the journal Birth followed 320 women and found that those who pushed spontaneously had fewer third-degree and fourth-degree tears. The reason is simple. When you push with your body’s natural rhythm, you push less forcefully and more gradually. This gives the perineal tissue time to stretch.

Directed pushing is not always bad. Some women do not feel the urge to push because of an epidural. In those cases, a provider may gently guide you on when to push. But even with an epidural, research suggests that waiting until the baby has descended lower before starting to push can reduce pushing time and the need for interventions.

Common Mistakes Women Make When Pushing

Pushing with your face. This is the most common mistake. Women hold their breath and strain, turning their face red and purple. All that effort goes into the head and neck, not the pelvis. If your face is tense, your pelvic floor is probably tense too. Keep your face relaxed. Imagine the energy moving down, not up.

Holding your breath too long. A 2019 study in the Journal of Obstetric, Gynecologic & Neonatal Nursing found that prolonged Valsalva maneuvers (breath-holding for more than 10 seconds) were linked to lower fetal oxygen saturation. Short pushes with good breathing are more effective than long, strained ones.

Pushing too early. Some women feel the urge to push before the cervix is fully dilated. If your provider tells you not to push yet, trust them. Pushing against an incompletely dilated cervix can cause swelling and delay labor. If the urge is overwhelming, ask for comfort measures like position changes or breathing techniques to help you through it.

Fighting the contraction. Contractions are uncomfortable. But tensing up against them makes pushing harder. Instead of clenching, try to open. Visualize your body opening like a flower. It sounds simple, but many women find it genuinely helpful.

How To Push During Labor With an Epidural

An epidural changes the pushing experience significantly. It reduces or eliminates the sensation of pressure. This means you may not feel the urge to push at all. Some women find this disorienting.

If you have an epidural, you will likely rely on your nurse or midwife to tell you when a contraction is starting. They can see it on the monitor. When the contraction begins, you push. When it ends, you stop. This is directed pushing by necessity, not by choice.

Some hospitals practice “laboring down” for women with epidurals. This means waiting for one to two hours after full dilation before starting active pushing. The baby continues to descend on its own during this time. A 2018 study in Obstetrics & Gynecology found that laboring down reduced total pushing time by an average of 30 minutes and did not increase risks for mother or baby.

Position matters even more with an epidural. You cannot stand or squat easily. But you can lie on your side. Side-lying pushing is associated with fewer perineal tears than lying on your back. You can also use a peanut ball between your legs to keep your pelvis open. Ask your nurse about positioning options.

What the Research Says About Prolonged Pushing

The American College of Obstetricians and Gynecologists defines prolonged pushing as more than three hours for first-time mothers and more than two hours for women who have given birth before. If an epidural is used, these limits extend by one hour.

Prolonged pushing is associated with higher rates of maternal infection, postpartum hemorrhage, and severe tearing. For babies, the risks include lower Apgar scores and higher rates of NICU admission.

But here is the nuance. These risks increase gradually, not suddenly. A woman who pushes for three hours and ten minutes is not in immediate danger. The decision to intervene with forceps, vacuum, or cesarean is based on the whole picture, not just the clock.

Some conditions make prolonged pushing riskier. If the baby is in a posterior position (facing up instead of down), pushing may take longer. If the baby’s heart rate shows signs of distress, intervention may be needed sooner. If you are running a fever or your water has been broken for many hours, your provider may recommend speeding things up.

What can you do if pushing is taking a long time? Change positions frequently. Try hands and knees, side lying, or squatting if you can. Empty your bladder completely. A full bladder can block the baby’s descent. Ask for a catheter if you cannot urinate on your own. Stay hydrated with ice chips or sips of water. And rest between contractions. Many women in prolonged pushing waste energy by not fully relaxing between pushes.