Breathing and Pushing

iStock_000020637307_MediumAs a physical therapist specializing in women’s pelvic floor and pregnancy, I focus on keeping women strong and pain free during pregnancy, while preparing for labor and delivery.

Although there are countless types of pushing techniques and breathing methods for labor, there are three main ones to be aware of:

  • Renewal Pelvic and Exhale Pushing™
  • Directed Pushing
  • Spontaneous Pushing

Understanding these will help you feel prepared to make an educated choice for yourself and your baby.


Renewal Pelvic and Exhale Pushing is a technique I developed after treating pregnant women for over a decade. It requires training and has to be practiced prior to the big day of labor. This technique is based not only on science and normal physiology but it also incorporates the pelvic floor and abdominal muscles.

Renewal Pelvic and Exhale Pushing™ involves three simultaneous actions:

  1. active exhalation
  2. engaging the transverse abdominal muscles (located on the front and side of the abdominal wall)
  3. a reverse Kegel, which is a technique for relaxing and releasing the pelvic floor.

The catch here is that you have to do all three actions at the same time. A common mistake with this technique is forcing the exhalation and/or over-activating the outer abdominal muscles instead of the transverse muscles.

Performing and practicing this pushing technique incorrectly can increase pelvic pressure, incontinence or organ prolapse. Don’t fear! Try it and practice it so you have another technique in your labor toolbox. Watch this video for more details:

Ending Pain In Pregnancy Video Excerpt, Exhalation Pushing for Labor Preparation from Isa Herrera, PSPT, CSCS.


Directed pushing is the most common and involves holding the breath for a certain count (usually to a count of ten) while you push, even though you may not have an urge to push. The pushing and breath holding usually occur for the duration of the contraction. The risk with directed pushing is that because you are holding your breath, directed pushing can make you tired. Also, it is correlated with a higher rate of perineal tearing and decreased oxygenation of blood for the baby and laboring mother. If there is fetal distress or if the baby is in danger, directed pushing can get the baby out very quickly and is used to protect the baby, but as a rule this type of breathing is not efficient and is not desirable.


Spontaneous pushing is natural and works with the rhythm of the laboring woman’s body. The laboring mom is in control and only pushes when she feels an urge to push. She is breathing through the contraction and not holding her breath. The woman is free and is not subjected to the commands of those in the room. She follows her instincts and is going with the labor. She is listening to her body and it will signal her when to push. This can be animalistic in nature and many sounds can come out of you when you are deep into your birthing process. Groaning, vocalizing and exhaling are all part of spontaneous pushing.

This is an ideal method and no training is required. It’s based on the deep messages of your body. Additionally, research has shown that women who use spontaneous pushing have shorter births and their babies have higher Apgar scores.

Excerpted from Ending Pain in Pregnancy by Isa Herrera, MSPT, CSCS. Ending Pain in Pregnancy offers women techniques to manage chronic vaginal, pelvic, sexual and lower back pain during and post pregnancy, as well as during birth. The book also includes  information on optimal labor positions and TENS therapy for natural pain relief. The best part is all the techniques in the book can be done at home.


isa-bookHEADSHOT-highREZIsa Herrera, MSPT, is a physiotherapist and clinical director at Renew Physical Therapy Center in New York City, where she specializes in pre- and post-natal care and pelvic floor issues. Her new book, Ending Pain in Pregnancy helps women stay strong and pain free while preparing and recovering from labor and delivery. Visit her website for more information or to order the book.

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Peggy O'Mara

About Peggy O'Mara

Editor and Publisher of Longtime natural living advocate, award winning writer, and independent thinker.

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