The pushing phase is the final stage of childbirth, marking the transition from labor to the delivery of the baby. It represents a significant physical effort, culminating the journey of pregnancy. Various approaches and positions are available to support the birthing person during this individualized stage.
Recognizing the Right Time to Push
The pushing phase typically begins when the cervix has fully dilated to 10 centimeters, meaning it has opened enough for the baby to pass into the birth canal. While 10 centimeters is the standard, full dilation does not always mean immediate delivery, as the baby may still need time to descend.
Many individuals experience a strong, instinctive urge to push, often described as a feeling similar to needing a bowel movement. This natural reflex signals the baby is moving down and applying pressure to the pelvic floor. If an epidural is in place, this natural urge may be diminished or absent, requiring guidance from healthcare providers. Pushing before full dilation can lead to cervical swelling or maternal exhaustion, so waiting for the right cues or professional guidance is important.
Effective Pushing Techniques and Positions
There are different approaches to pushing, primarily spontaneous and directed pushing. Spontaneous pushing, also known as physiological or mother-led pushing, involves following the body’s natural urges to bear down. This technique often involves pushing for about five seconds, taking a few short breaths, and then pushing again, allowing the birthing person to work with their body’s rhythm. Spontaneous pushing may lead to shorter pushing times and higher Apgar scores for the baby in unmedicated labors.
Directed pushing, also known as Valsalva or coached pushing, involves taking a deep breath, holding it, and bearing down forcefully for about 10 seconds during contractions. This method is frequently used in hospital settings, especially with epidural use, as it provides clear guidance when the natural urge to push might be absent. While effective for rapid delivery, it may carry risks such as increased maternal blood pressure and reduced oxygen flow to the baby.
Pushing Positions
Various positions can optimize the pushing experience.
Squatting uses gravity and can increase the pelvic outlet by up to 28%, creating more space for the baby to descend. Supported squatting, using a birthing bar or partner, can reduce strain.
Side-lying positions reduce the risk of perineal tearing, provide rest, and aid in fetal rotation.
Hands and knees positions relieve back pain and help the baby rotate into an optimal position.
Semi-reclined positions are common, though upright or gravity-neutral positions may offer advantages.
Optimizing Your Pushing Experience
Breathing techniques are important for managing the pushing phase. Open-glottis pushing involves exhaling as you bear down, often with grunts or moans. This helps maintain oxygen supply for both the birthing person and the baby and may reduce the risk of pelvic floor trauma. This contrasts with closed-glottis pushing, where breath is held forcefully. Focusing on sustained exhalations or humming can help direct energy downward.
Listening to the body’s cues and allowing instincts to guide the process can enhance the pushing experience. A supportive partner or doula can provide encouragement, physical comfort, and help navigate decisions. Staying hydrated and conserving energy between contractions are also important for sustaining the physical demands of pushing. Resting between contractions helps manage fatigue and prepare for the next effort.
Understanding Pushing Progress
As pushing progresses, healthcare providers monitor both the birthing person and the baby. Fetal monitoring, either intermittent using a handheld Doppler or continuous with external monitors, assesses the baby’s heart rate and well-being. The baby’s descent through the birth canal is observed, with crowning indicating the baby’s head is visible at the vaginal opening. Crowning often feels like intense pressure or a burning sensation.
The “fetal ejection reflex” is when the uterus powerfully contracts, helping to expel the baby with minimal conscious effort, though not everyone experiences this. Healthcare providers guide efforts to allow vaginal tissues to stretch gradually, potentially reducing the risk of tearing. The pushing phase culminates in the birth of the baby, followed shortly by the delivery of the placenta.