Pushing during labor is a physical skill, not just a reflex. The most effective approach is to follow your body’s own urge to bear down, take a full breath, and push while exhaling slowly rather than holding your breath for long periods. Research consistently shows that spontaneous pushing — working with your contractions instead of against them — is generally as safe as coached, breath-holding pushing, and it often feels more manageable. This guide explains what actually happens during the second stage of labor, how to push in a way that conserves your energy, and what the evidence does and does not support.
What Happens During the Pushing Stage of Labor?
The pushing stage is the second stage of labor. It begins when the cervix is fully dilated — 10 centimeters — and ends when the baby is born. For a first-time mother, this stage often lasts anywhere from 30 minutes to a few hours. For women who have given birth before, it tends to be shorter.
During this stage, the baby moves down through the birth canal. The pressure of the baby’s head against the tissues of the pelvis and perineum triggers a reflex urge to push. That urge is often described as an overwhelming need to bear down, similar to a strong bowel movement.
Contractions during this stage may feel different from earlier labor. They can be longer and spaced further apart, which gives you brief recovery windows between them. The uterus does most of the work. Pushing adds your effort on top of what the uterus is already doing.
Some women feel a clear, irresistible urge to push right away. Others need to wait while the baby descends further. If you have an epidural, the urge may be dulled or absent, and your care team may guide you on when to push.
How Do You Push Effectively During Labor?
Effective pushing means working with your contractions, not exhausting yourself against them. The key is to direct your effort downward and to avoid holding your breath for extended periods.
When a contraction builds, take a comfortable breath in. Then bear down as you exhale slowly through your mouth. Keep your chin slightly tucked toward your chest and curl your upper body forward if you can. This position helps direct the force where it needs to go.
Avoid clenching your face or tensing your shoulders. That tension wastes energy and does not help the baby move. Let your jaw and shoulders stay relaxed.
Between contractions, rest completely. Even 30 to 60 seconds of full relaxation helps you recover for the next push. Do not keep pushing when there is no contraction.
Most people push about three to five times per contraction. But this is not a rule. If you feel you can only manage two good pushes before the contraction fades, that is fine. Quality matters more than quantity.
One non-obvious point: the breath-holding technique you may have seen in movies — where someone holds their breath for a count of ten while pushing — is not clearly better than other methods. Research comparing these approaches has generally found similar outcomes for mothers and babies. Some studies suggest that prolonged breath-holding may reduce oxygen flow to the baby temporarily, though the clinical significance of this is debated. Working with your exhale is a reasonable and widely used approach.
What Is the Difference Between Spontaneous and Directed Pushing?
There are two main styles of pushing, and the evidence on which is better is mixed.
Spontaneous pushing means you push when you feel the urge, following your body’s signals. You choose when and how long to push. This is sometimes called “laboring down” or “delayed pushing.”
Directed pushing means your care team tells you when to push, often counting to ten while you hold your breath. This is sometimes called “coached pushing.”
Some studies suggest spontaneous pushing may lead to slightly less fatigue and a lower risk of certain pelvic floor issues. Other studies have found no meaningful difference in outcomes. The evidence is genuinely mixed, and different hospitals and providers have different approaches.
If you have an epidural, you may not feel the urge to push. In that case, directed pushing may be necessary. Some providers recommend waiting a period of time after full dilation before starting to push, especially with an epidural. This is called “delayed pushing” or “laboring down.” Research on this approach has shown mixed results, with some studies suggesting it may reduce certain complications and others finding no clear benefit.
What Positions Help You Push More Effectively?
Upright and side-lying positions are generally more effective than lying flat on your back. Gravity helps, and these positions may open the pelvis slightly.
Positions that may help include:
- Semi-sitting, with the head of the bed raised
- Squatting, supported by a partner or bar
- Hands and knees
- Side-lying, especially if you have an epidural
Lying flat on your back is common in some hospital settings, but it works against gravity and may make pushing harder. If you have an epidural, you may be limited in how much you can move. Your care team can help you find a position that works with your level of mobility.
Changing positions during the pushing stage is generally fine and may help if progress is slow. There is no single best position for everyone.
How Long Should You Push?
There is no fixed time limit that applies to everyone. The length of the pushing stage varies widely based on whether it is your first birth, whether you have an epidural, the baby’s position, and other factors.
For a first birth, the pushing stage often lasts between 30 minutes and two to three hours. For subsequent births, it is often shorter. These are general ranges, not rules.
Your care team will monitor both you and the baby throughout. They will check the baby’s heart rate regularly and assess how the baby is moving down. If progress stalls or if there are concerns about the baby, they may recommend interventions.
It is worth knowing that some guidelines allow for a longer pushing stage than was once considered standard, as long as both mother and baby are doing well. The decision to intervene is based on the whole picture, not just the clock.
What Should You Avoid During Pushing?
Some common habits can work against you during the pushing stage.
Avoid holding your breath and straining for long periods. This can reduce oxygen to the baby and may increase fatigue. Short, directed pushes with an exhale are generally preferred.
Avoid pushing when you have no contraction and no urge. Pushing between contractions does not help and drains your energy.
Avoid tensing your face, neck, and shoulders. This is common but counterproductive. Try to keep your jaw loose and your shoulders down.
Avoid ignoring pain that feels different from contraction pain. Severe, tearing pain or pain that does not come and go with contractions should be reported to your care team right away.
If you have an epidural, avoid assuming you cannot push effectively. Many people with epidurals push successfully. You may just need more guidance on when and how to push.
Frequently Asked Questions
How do you push effectively during labor?
Take a full breath in, then bear down while exhaling slowly, keeping your chin tucked and your body relaxed. Push only during contractions, and rest completely between them.
Is it better to hold your breath or exhale while pushing?
Research has not shown a clear advantage of holding your breath over exhaling while pushing. Exhaling may help you avoid prolonged strain and keep oxygen flowing to the baby.
How long does the pushing stage usually last?
For a first birth, the pushing stage often lasts between 30 minutes and two to three hours. For subsequent births, it is often shorter, though these are general ranges and not fixed limits.
Can you push effectively with an epidural?
Yes, many people push effectively with an epidural, though you may need more guidance since the urge to push can be dulled. Your care team can help you time your pushes with contractions.
