The second stage of labor, the time between full cervical dilation and the birth of the baby, requires significant physical effort. During this phase, effective breathing is a functional tool for maximizing the force of the uterus and abdominal muscles, not just a method of pain management. Proper respiratory technique helps maintain adequate oxygen saturation for both the birthing person and the fetus during the intense physical exertion of pushing. The way one breathes directly influences the efficiency of the push and the potential for maternal fatigue. Understanding the mechanics of breathing during this stage helps direct energy effectively and supports a safe delivery.
The Core Technique: Breathing for Effective Pushing
When a birthing person is coached by medical staff—often known as “directed pushing”—the breathing technique focuses on generating sustained, downward pressure. This approach is frequently utilized when a person has an epidural, which can mute the body’s natural urge to push. The technique begins with a deep, cleansing inhalation taken as the contraction reaches its peak intensity.
Following this deep breath, the person is often instructed to bear down as if having a bowel movement, focusing the force into the pelvis. Crucially, this push should be performed with an “open glottis,” meaning the air is slowly released through the mouth with a grunt or a low-toned vocalization, rather than being held completely. The push is typically maintained for a short duration, usually around five to seven seconds, before exhaling the remaining air.
This open-glottis, directed pushing technique allows for a powerful effort while preventing the cessation of oxygen flow. After the short, sustained push, a quick recovery breath should be taken, and the cycle repeated two to three times per contraction. The goal is to channel the force of the contraction into the expulsion while minimizing maternal exhaustion or fetal distress.
Spontaneous Pushing: Listening to Your Body’s Cues
Spontaneous pushing, also called physiologic or mother-led pushing, is an evidence-based alternative that relies on the body’s natural “fetal ejection reflex.” This method involves waiting until the birthing person feels an overwhelming, undeniable urge to push, which may not occur immediately upon reaching full cervical dilation. The associated breathing pattern is entirely responsive to this internal cue, allowing for a more intuitive and less fatiguing process.
The breathing between pushes is deep, natural, and rhythmic, promoting relaxation and maximizing oxygenation during the resting period of the contraction. When the urge to push arrives, it is often characterized by multiple, shorter pushes that naturally follow the rhythm of the body, rather than one long, sustained effort. This open-glottis approach naturally encourages the slow and controlled descent of the baby.
During these spontaneous pushes, the birthing person is encouraged to follow their instincts, often including exhaling, grunting, or vocalizing as they bear down. This technique has been shown to reduce the incidence of perineal trauma and pelvic floor injury compared to highly directed pushing. Prioritizing maternal control and working with the body’s natural timing can reduce overall maternal fatigue.
Outdated Techniques: What to Avoid During the Second Stage
Historically, the Valsalva maneuver was a common technique taught for labor, but it is now largely discouraged by modern obstetrical practice. This method involves taking a deep breath and holding it (closing the glottis) while pushing with maximum force for ten seconds or more. This is sometimes referred to as “purple pushing” because the effort can cause the birthing person’s face to become flushed from strain.
The primary concern with the Valsalva maneuver is its impact on circulation and oxygen transfer. Holding the breath for extended periods significantly increases intrathoracic and intra-abdominal pressure, which temporarily reduces the blood flow returning to the heart. This decrease in maternal blood flow can subsequently reduce the amount of oxygen reaching the placenta and the fetus.
Sustained breath-holding can lead to rapid maternal exhaustion and an increased risk of perineal tearing due to the sudden, forceful pressure. Current guidelines recommend avoiding this outdated practice. Instead, open-glottis pushing is preferred, as it better preserves oxygen levels for both the mother and the baby throughout the second stage of labor.