The process of childbirth culminates in the second stage of labor, a phase defined by the body’s powerful expulsive efforts. This stage begins once the cervix has fully dilated to 10 centimeters and concludes with the birth of the baby. Understanding how to push effectively means learning to work in harmony with the body’s natural design. The body is equipped with sophisticated physiological reflexes intended to facilitate the passage of the baby. The goal is to maximize the force of uterine contractions while preserving maternal energy and maintaining optimal oxygenation for both the birthing person and the baby.
Recognizing the Onset of the Second Stage
The transition from the first stage of labor to the second stage is marked by the full dilation of the cervix. The second stage is typically divided into a passive phase and an active phase. In the passive phase, the baby continues to descend through the pelvis, but the birthing person may not yet feel an overwhelming urge to push.
The active phase is signaled by the involuntary compulsion to bear down, triggered by the baby’s head pressing on the pelvic floor. This phenomenon is often referred to as the Ferguson Reflex, where pressure stimulates the release of oxytocin, intensifying contractions. The reflex creates an instinctive urge to push. Contractions during this phase become stronger and longer, though they may occur with longer intervals between them, allowing brief periods for rest.
Mastering Pushing Techniques
The specific technique used during the active pushing phase impacts maternal exhaustion and fetal well-being.
Open-Glottis Pushing
Modern obstetrics encourages a physiological or spontaneous approach, often called “open-glottis” pushing. This method involves following the body’s urges to bear down, resulting in shorter, more frequent pushes during a contraction. The birthing person exhales or makes noise while pushing, keeping the glottis open.
Open-glottis pushing is considered gentler because it lowers intra-abdominal pressure, which helps maintain blood flow and oxygen supply to the baby. This approach is associated with a lower risk of pelvic floor injury and less maternal fatigue. The focus should be on engaging the deep abdominal muscles, similar to the effort used during a bowel movement, while relaxing the pelvic floor.
Closed-Glottis Pushing
In contrast, “directed” or “closed-glottis” pushing, also known as the Valsalva maneuver, involves taking a deep breath and holding it for up to 10 seconds while forcefully bearing down. This technique generates higher, sustained intra-abdominal pressure, which can move the baby out faster. However, this “purple pushing” method restricts air flow, potentially reducing oxygen transfer to the baby and increasing maternal blood pressure and risk of pelvic floor trauma.
While closed-glottis pushing is generally discouraged for routine use, it may be employed when a rapid delivery is medically warranted, such as in cases of fetal distress. If directed pushing is necessary, the birthing person should be guided to push with contractions using short efforts of about six to seven seconds with normal breathing in between.
Optimizing Pushing Positions
The position chosen for pushing influences the shape and capacity of the pelvis. Upright positions, such as squatting, standing, sitting, or kneeling, leverage gravity to assist the baby’s descent through the birth canal. Using gravity can lead to a shorter second stage of labor and may reduce the need for assisted delivery.
An upright posture allows the sacrum to move freely, which effectively widens the pelvic outlet. Lying flat on the back, or in the supine position, is considered one of the least effective positions because it restricts sacral movement and forces the birthing person to push “uphill” against gravity. Lying on the back can also compress major blood vessels, potentially reducing blood flow and oxygen to the baby.
Adopting lateral positions, such as side-lying, can be a beneficial alternative, especially for managing pain or when an epidural is in place. The side-lying position prevents compression of the main blood vessels and can help the baby rotate into a more favorable position. Changing positions frequently throughout the second stage is beneficial, as it encourages movement and helps the pelvis adapt to the baby’s journey.
Pacing and Sustaining Effort
The second stage of labor can last from a few minutes to several hours, making energy conservation a primary concern. It is important to utilize the rest periods between contractions to fully relax and regain strength. The body needs these recovery periods to ensure both maternal and fetal well-being, as the uterus requires time to reoxygenate between expulsive efforts.
Effective pushing is a series of managed efforts synchronized with contractions. The birthing person should push when the contraction peaks and the urge is strongest, stopping completely when the contraction fades. This spontaneous pacing is less fatiguing than being directed to push for prolonged periods.
Communication with the care team is important as the baby’s head begins to emerge, a phase known as crowning. The provider may ask the birthing person to stop pushing or to use short, gentle breaths to slow the baby’s exit. This controlled delivery allows the perineum to stretch slowly, which reduces the risk of severe tearing.