The act of “bearing down” is the voluntary physical effort used to push a baby through the birth canal during childbirth. This action involves engaging the abdominal muscles to exert downward pressure, mimicking the intense strain felt during a large bowel movement. Effective pushing during the second stage of labor supplements involuntary uterine contractions, applying the necessary force to move the baby past the pelvic bones. Efficiently harnessing this expulsive energy can significantly affect the length of the pushing stage and the overall birth experience.
Understanding the Second Stage of Labor
The second stage of labor begins when the cervix is fully dilated to 10 centimeters and ends with the baby’s birth. This stage is divided into a passive phase and an active phase. The passive phase occurs right after full dilation, when the person giving birth may not yet feel a strong urge to push, especially with an epidural.
The active phase starts when a person feels an involuntary, overwhelming urge to bear down, known as the “Ferguson reflex.” This reflex is triggered by the baby’s head pressing on the pelvic floor and nerves, signaling the brain to release oxytocin. Oxytocin intensifies contractions and the expulsive urge. Medical guidance recommends waiting until full cervical dilation is confirmed to prevent injury or swelling of the cervix. Delaying active pushing until the urge is strong, sometimes called “laboring down,” can conserve maternal energy and reduce active pushing time.
Comparing Pushing Techniques
Bearing down is categorized into two main techniques: directed pushing and spontaneous pushing. Directed pushing, also known as closed-glottis pushing or the Valsalva maneuver, involves taking a deep breath, holding it for about ten seconds, and pushing while counting to ten. Healthcare providers often coach this method, especially when an epidural mutes the natural urge.
Directed pushing can shorten the second stage of labor, but it may lead to maternal exhaustion. It can also potentially reduce oxygen flow to the baby as prolonged breath-holding is sometimes called “purple pushing.”
Spontaneous pushing, or open-glottis pushing, encourages following the body’s natural instincts and pushing only when the urge is felt. This technique uses shorter, multiple pushes—typically three to five efforts lasting five to seven seconds each—per contraction. Pushing is often accompanied by grunting or exhaling rather than holding the breath.
This approach respects the natural physiological process and may lead to less perineal trauma and maternal fatigue because it promotes better oxygen exchange. The goal is to direct the pushing effort toward the rectum, similar to straining for a bowel movement. Pushing into the face is less effective for descent and can cause strain.
Optimizing Positions for Delivery
The position chosen for delivery significantly impacts the effectiveness of bearing down by utilizing gravity and optimizing pelvic dimensions. Lying flat on the back (supine position) is the least advantageous because it can compress major blood vessels, reducing blood flow, and may narrow the pelvic outlet. Upright or gravity-neutral positions are more effective because they align the pelvis to create more space for the baby’s descent.
Positions that use gravity, such as squatting, sitting upright, or kneeling, help the baby move down the birth canal more efficiently. Squatting can increase the pelvic outlet diameter by up to 10 to 15 percent, assisting in the final stages of bearing down. Hands-and-knees or side-lying positions are excellent gravity-neutral alternatives. These positions can help rotate a poorly positioned baby and take pressure off the perineum, potentially reducing the risk of tearing. Changing positions frequently throughout the second stage is beneficial for comfort and encouraging the baby to navigate the curves of the pelvis.
The Importance of Guided Support
The support team, including a partner, doula, nurse, or doctor, plays a major role during the intense expulsive phase of labor. This support encompasses physical assistance, emotional encouragement, and guidance on timing and technique. Partners can offer counter-pressure or massage, help adjust positioning, and provide a steady presence, which reduces anxiety and enhances the birthing person’s ability to focus.
Guidance from a healthcare professional is important for deciding when to begin active pushing, especially if an epidural mutes the natural urge. The support team should communicate effectively, reminding the person to breathe between pushes and offering reassurance of their progress. A supportive and calm environment, attuned to the birthing person’s needs, is a component of a successful bearing-down experience.