When I was pregnant with my first child, I attended a comprehensive 12-week childbirth class. We practiced breathing exercises, learned about pain management options, and toured the hospital. But when it came to the actual mechanics of pushing? We got a five-minute overview and a vague instruction to “push like you’re having a bowel movement.”
That explanation left me completely unprepared for the reality of the pushing stage. Like many women, I discovered that how to push during labor is far more nuanced than childbirth classes typically reveal. The techniques I’m about to share come from labor and delivery nurses, pelvic floor physical therapists, and experienced birth coaches. These are the methods that help women push effectively, protect their pelvic floors, and work with their bodies rather than against them.
Whether you’re planning a natural childbirth or preparing for an epidural, understanding these evidence-based pushing techniques can transform your birth experience from one of confusion and frustration to confidence and empowerment.
Table of Contents
Why Your Childbirth Class Might Not Have Covered Pushing
Most standard childbirth education focuses heavily on the first stage of labor: recognizing contractions, timing them, and managing pain. There’s a practical reason for this imbalance. The first stage is typically the longest, and preparation helps reduce anxiety during those early hours at home.
But the second stage of labor – the pushing phase – is often treated as an afterthought. Many instructors assume the urge to push will be instinctive, that your body will simply know what to do. For some women, this is true. For others, especially first-time mothers or those with epidurals, the physical mechanics of pushing remain a mystery until they’re in the delivery room with a nurse counting to ten.
Research published in the American Journal of Obstetrics and Gynecology confirms that coached pushing (being told when and how to push) doesn’t necessarily lead to better outcomes than spontaneous pushing (following your body’s urges). Yet most hospital protocols still rely heavily on coached techniques. Understanding both approaches gives you options and confidence regardless of your birth setting.
The Physiology of Pushing: Understanding Your Body’s Design
Before diving into specific techniques, let’s look at what actually happens during the pushing phase. Understanding the physiology helps you work with your body rather than fighting against it.
The Pelvic Floor and Diaphragm Connection
Your pelvic floor is a group of muscles that form a sling at the base of your pelvis. During pregnancy, these muscles support your growing uterus and baby. During birth, they need to relax and stretch to allow your baby to pass through. The challenge many women face is that the pelvic floor muscles are often tense without us realizing it.
The diaphragm, your primary breathing muscle, sits at the base of your rib cage. When you breathe deeply, your diaphragm descends and creates gentle pressure in your abdomen. When you bear down intentionally, you engage your abdominal muscles to create stronger downward pressure. The key to effective pushing is coordinating these muscle groups: relaxing the pelvic floor while engaging the diaphragm and deep core muscles.
Think of it like this: you need to open the door (pelvic floor relaxation) while simultaneously pushing something through it (diaphragm and abdominal engagement). Most childbirth classes only teach the pushing part without addressing the opening.
What the Urge to Push Actually Feels Like
Many women describe the urge to push as intense rectal pressure, similar to the sensation of needing to have a bowel movement. Some feel it as pressure in their lower back or vagina. As the baby’s head descends, this pressure typically becomes impossible to ignore.
If you have an epidural, you might not feel this urge clearly. This is why specific techniques for pushing with reduced sensation are essential – and rarely covered in standard classes.
Open Glottis vs Closed Glottis Pushing: Which Is Right for You?
The debate between open glottis and closed glottis pushing represents one of the most significant gaps in standard childbirth education. Understanding both approaches allows you to choose what works best for your body and situation.
Closed Glottis Pushing (The Valsalva Maneuver)
Closed glottis pushing, commonly called the Valsalva maneuver, is what most hospitals teach by default. You take a deep breath, hold it, close your glottis (the opening between your vocal cords), and push while counting to ten. This is the “purple pushing” you see in movies – holding your breath, bearing down with your face scrunched up.
The advantage of closed glottis pushing is that it creates strong intra-abdominal pressure, which can be effective for moving the baby down quickly. However, research shows this technique can reduce oxygen flow to you and your baby, increase perineal tearing risk, and put unnecessary strain on your pelvic floor.
A study in the Cochrane Database found that while closed glottis pushing might shorten the second stage slightly, it increases the risk of severe perineal tears and abnormal fetal heart rate patterns.
Open Glottis Pushing
Open glottis pushing involves exhaling while bearing down, keeping your throat open and making sound. Instead of holding your breath, you take a breath at the beginning of the contraction, then slowly exhale with a grunt, moan, or hiss while pushing. You can take multiple breaths during a single contraction, pushing in several shorter bursts rather than one long sustained push.
The benefits are significant: better oxygen flow to you and your baby, reduced pelvic floor strain, less perineal trauma, and more intuitive control over your pushing effort. Many women find it more sustainable during long pushing phases.
The trade-off is that open glottis pushing might take slightly longer in some cases. However, for most women, the benefits to pelvic floor health and reduced tearing risk outweigh any minimal time difference.
How to Choose
Consider open glottis pushing as your default technique, especially if preventing perineal tearing is a priority. You might choose closed glottis pushing if your baby needs to be delivered quickly due to distress, or if your care provider specifically recommends it based on your situation.
The best approach is often a hybrid: using open glottis for most of the pushing phase, then switching to closed glottis if you need extra power for the final delivery.
The Correct Way to Push: Step-by-Step Instructions
If you’re looking for a clear, actionable guide to pushing, here’s the step-by-step method that combines the best techniques from labor nurses and pelvic floor therapists. This approach works for most women in most birth situations.
Step 1: Wait for the urge or your contraction peak. Whether you’re doing coached or spontaneous pushing, the most effective pushes happen when you’re working with your body’s natural rhythm.
Step 2: Take a deep breath. Fill your lungs completely, allowing your rib cage to expand.
Step 3: Tuck your chin to your chest. This creates alignment through your spine and helps direct the pushing force downward rather than outward.
Step 4: Curl around your baby. Round your back slightly and pull your knees back toward your shoulders (or have your partner support them).
Step 5: Relax your pelvic floor. This is the step most women skip. Consciously release tension in your perineal area. Imagine your sitz bones (the bones you feel when sitting on your hands) spreading apart.
Step 6: Bear down with your breath. For open glottis: exhale slowly while making a low sound. For closed glottis: hold your breath and push. Aim for 6-8 seconds of continuous pressure.
Step 7: Release and breathe. Take a quick breath, then push again. Aim for 2-4 pushes per contraction.
Step 8: Rest between contractions. Completely relax your body, soften your jaw, and prepare for the next wave.
Practice these steps before labor. Lie on your back with your knees bent, place your hands on your lower abdomen, and work through the sequence. You should feel your belly firm as you engage your deep core muscles.
Partner-Assisted Techniques That Create More Space
These techniques are virtually never covered in hospital-based childbirth classes, yet they can make a significant difference in how quickly and comfortably your baby descends. They require a birth partner who understands the mechanics and can provide physical support.
Single Knee Press
The Single Knee Press addresses one of the most common issues during pushing: a baby whose head is positioned slightly off-center in the pelvis. When one side of the pelvis is tighter than the other, it can create asymmetry that slows descent.
Here’s how it works: While you’re pushing in a side-lying or semi-reclined position, your partner places the palm of their hand against the outside of your top knee. As you push, they apply steady pressure inward, toward the bed or floor. This creates internal rotation in your hip, which opens space on that side of your pelvis.
The technique works because it targets the sitz bones and pubic arch, creating more room where the baby needs it most. Many women report immediate relief and more effective pushing when this technique is applied correctly.
Cook’s Counter Pressure
Developed by birth educator and doula Gail Tully, Cook’s Counter Pressure addresses sacral tightness that can impede the baby’s descent. The sacrum is the triangular bone at the back of your pelvis that needs to move backward slightly during birth to create outlet space.
Your partner stands behind you and applies firm, steady pressure to your sacrum (the flat area just above your tailbone) using the heel of their hand or a tennis ball wrapped in a towel. The pressure should be directed forward and slightly up, toward your navel.
This technique is particularly helpful if you’re experiencing back labor or if your baby is in an occiput posterior position (facing your belly rather than your back). The counter pressure opens the pelvic outlet and can significantly reduce pushing time.
How to Practice These Techniques Before Birth
These partner techniques work best when your support person has practiced them beforehand. Set aside time in your third trimester to work through the positions and pressure points. Use pillows to simulate your body position, and practice the pressure and timing.
Remember that your partner is supporting you, not directing you. The best partner support responds to your cues and adjusts pressure based on your feedback.
Pushing Positions Your Hospital Might Not Suggest
The lithotomy position – lying flat on your back with your legs in stirrups – is the default pushing position in most American hospitals. Yet it’s one of the least effective positions for facilitating birth. Gravity works against you, the pelvic outlet is at its narrowest, and you’re bearing all the effort without natural assistance.
Alternative pushing positions can shorten labor, reduce tearing, and give you more control. Here are the positions that birth professionals recommend most highly.
Hands and Knees
This position – on all fours with your hands and knees supporting your weight – offers multiple advantages. Gravity assists the baby’s descent, the pelvic outlet opens wider, and there’s less pressure on your tailbone. If you’re experiencing back labor, hands and knees often provides immediate relief.
Many women instinctively move to this position during intense labor. The rocking motion you can create while on hands and knees also helps the baby navigate through the birth canal.
Side-Lying
Lying on your side with your top leg supported by your partner or a peanut ball is an excellent option if you’re tired or have an epidural. This position keeps the pelvis open while allowing you to rest between contractions. It’s also one of the best positions for protecting your perineum from tearing.
To optimize side-lying for pushing, keep your top knee bent and pulled up toward your chest while your bottom leg remains straight. Your partner can support your top leg or use the peanut ball to maintain the position.
Asymmetrical Positions
Sometimes called the “running start” position, asymmetrical pushing involves one knee bent up toward your chest while the other leg extends downward. This opens one side of the pelvis more than the other, which can help a baby who is slightly stuck rotate into a better position.
You can do this standing, kneeling, or lying on your side. Switch sides if progress stalls to see if the asymmetry helps.
Position Transitions During Pushing
One of the most effective strategies that standard classes rarely mention is changing positions during the pushing phase itself. If you’ve been pushing for a while without progress, simply switching positions can shift the baby’s head and create new momentum.
Try spending 3-4 pushes in one position, then switching to another. The movement itself stimulates different muscle groups and can help the baby navigate any tight spots in your pelvis.
How to Push During Labor with an Epidural
Pushing with an epidural presents unique challenges that most childbirth classes don’t adequately address. The numbness that relieves contraction pain also dulls the sensations that typically guide pushing. Without the urge to push as a clear signal, many women feel lost and ineffective during the second stage.
These techniques are specifically designed for women laboring with epidurals.
Delayed Pushing or Laboring Down
Research supports waiting to push until you feel significant rectal pressure, even with an epidural. This approach, called delayed pushing or laboring down, allows your uterus to continue working while you rest. Your body does the early work of bringing the baby down without your active effort.
Studies show that laboring down for 60-90 minutes after reaching full dilation can significantly shorten the active pushing phase and reduce the risk of perineal tears. During this time, you might feel pressure building but not yet feel the urge to actively push.
Working with Reduced Sensation
When you do begin pushing with an epidural, focus on the pressure sensations you can still feel. Most women retain some sensation of rectal pressure even with a strong epidural. Use that pressure as your guide rather than waiting for the nurse to tell you when to push.
Your birth partner can help by watching the contraction monitor. They can tell you when a contraction is beginning (giving you a moment to prepare) and when it peaks (the optimal time for your strongest push).
Position Considerations
With an epidural, you’ll need support to maintain most positions. Side-lying with a peanut ball is often the most accessible option. Some hospitals support hands-and-knees pushing even with an epidural if you have adequate support people.
Remember that you can request the epidural be turned down or adjusted if you want more sensation for pushing. Some women find that lightening the epidural allows them to push more effectively while still managing pain.
Protecting Your Pelvic Floor: Pushing Techniques That Prevent Tearing
Perineal tearing is one of the most common fears women have about vaginal birth. While some tears are unavoidable, research shows that specific pushing techniques can significantly reduce both the likelihood and severity of tearing.
The Knees-Together Technique
Pelvic floor physical therapist Rachel Pieton popularized this simple but effective technique. Instead of pushing with your knees wide apart, bring them closer together – almost touching – while pushing. This positioning creates more space in the pelvic outlet while reducing strain on the perineal tissues.
The mechanics behind this are fascinating. When your knees are wide, your sitz bones (ischial tuberosities) move apart, but your pubic arch remains relatively narrow. When your knees come together, the pubic arch widens, creating more room for the baby’s head while your perineum is protected by the closed position.
To use this technique, start pushing with your knees wide. As you feel the baby crowning (the ring of fire sensation), bring your knees together and push more gently. Many women report this is the most comfortable way to deliver the head and shoulders.
Perineal Support and Warm Compresses
Having your care provider or partner apply gentle counter-pressure to your perineum during crowning can help tissues stretch gradually rather than tearing suddenly. A warm compress applied to the perineum during pushing has also been shown to reduce tearing risk.
Slow Pushing for the Head
Once the baby’s head is crowning, switch to small, gentle pushes rather than strong bearing-down efforts. Allow the tissues to stretch gradually around the baby’s head. This might mean pushing through 2-3 additional contractions after crowning begins, rather than powering through in one push.
Breathing techniques that keep the pelvic floor relaxed are essential here. Low humming or long exhales help maintain the openness you need while preventing the involuntary tightening that can lead to tears.
Sound, Movement, and the Mind-Body Connection
The final techniques we’ll cover address something that doesn’t fit neatly into medical textbooks: the profound connection between your mental state, your voice, and your body’s ability to birth effectively.
Vocalization as a Pushing Aid
Making sound during pushing isn’t just permissible – it’s beneficial. Low-pitched sounds (moans, grunts, deep exhales) help keep the throat and jaw relaxed, which in turn signals the pelvic floor to stay open. High-pitched sounds or holding your breath creates tension that travels down through your body.
Try this: Tighten your jaw and make a high-pitched sound. Notice how your shoulders and neck tense. Now relax your jaw, drop your shoulders, and make a low “ahhh” or “ohhh” sound. Feel how that relaxation extends down through your torso.
During pushing, experiment with different sounds. Many women find a low hum most effective. Others prefer open-mouthed grunts or even laughter (yes, some women laugh during pushing, and it works beautifully for them).
Intuition-Led Pushing
There’s a growing movement toward spontaneous pushing – following your body’s urges rather than coached instructions. Research shows that women who push when they feel the urge, in the way their body directs, often have shorter second stages and less perineal trauma.
This requires releasing the mental need to “perform” pushing correctly. Your body knows how to birth. Your job is to get out of your own way and let the ancient wisdom of your physiology lead.
If you’ve never been particularly athletic or in touch with your body, this might sound impossible. Start practicing now. Lie down, place your hands on your belly, and simply notice sensations. Practice bearing down without tension. The more familiar you are with these sensations before labor, the more confident you’ll feel using them during birth.
When NOT to Push: Understanding the Signals
Sometimes the most important pushing technique is knowing when to stop pushing. This section covers the situations where pushing can actually hinder progress or cause complications.
A cervical lip occurs when a small portion of cervix hasn’t fully dilated while the rest is at 10 centimeters. Pushing against a cervical lip can cause swelling that stalls labor completely. If you feel an urge to push before your care provider confirms full dilation, resist the urge and use breathing techniques to manage the sensation.
If your nurse tells you not to push, there’s usually a good reason. Trust their guidance even when it feels counterintuitive. Techniques like quick, shallow breathing (panting) can help you ride out the urge to push when pushing isn’t appropriate.
Physiological pushing – waiting for your body to give clear signals – often resolves these timing issues naturally. Your body typically won’t create a strong urge to push until the cervix is fully out of the way.
FAQs
What is the correct way to push during labor?
The correct way to push involves coordinating your breath with abdominal muscle engagement while relaxing your pelvic floor. Take a deep breath, tuck your chin to your chest, curl around your baby by pulling your knees toward your shoulders, relax your pelvic floor muscles, and bear down for 6-8 seconds. Release, breathe, and repeat for 2-4 pushes per contraction. Open glottis pushing (exhaling while bearing down) is generally preferred over closed glottis pushing (holding your breath).
What is the 5-1-1 rule for labor?
The 5-1-1 rule is a guideline for when to head to the hospital or call your midwife. It means contractions are 5 minutes apart, lasting 1 minute each, and this pattern has continued for 1 hour. Some providers use a 4-1-1 or 3-1-1 variation. This rule applies to the first stage of labor, not the pushing stage. Once you’re pushing, you’re typically already at your birth location. There’s also a 3-2-1 pushing rule: take a deep breath, push for 3 counts, release for 2 counts, and repeat 1 more time per contraction peak.
How to push for safe delivery?
For the safest delivery, focus on protecting your perineum by bringing your knees together as the baby crowns, using open glottis pushing to maintain oxygen flow, and working with a pelvic floor physical therapist before birth if possible. Change positions every few pushes if progress stalls. Consider delayed pushing if you have an epidural. Use perineal support and warm compresses during crowning. Push gently when the baby’s head is emerging rather than using maximum force.
Why do nurses say not to push during labor?
Nurses may tell you not to push if your cervix isn’t fully dilated (10 cm), if there’s a cervical lip (a small portion of cervix that hasn’t opened fully), or if the baby is in a position that needs adjustment before descent. Pushing too early can cause cervical swelling that stalls labor or leads to complications. Sometimes the urge to push comes before full dilation, especially with rapid labors. In these cases, techniques like panting breathing help you resist the urge until it’s safe to push.
Is there a wrong way to push during labor?
Yes, there are pushing approaches that can cause problems. Pushing before full dilation can create complications. Closed glottis pushing (holding your breath while bearing down) reduces oxygen flow to you and your baby and increases perineal tear risk. Pushing with a tense pelvic floor works against your body’s natural process. Bearing down flat on your back without position changes makes pushing less effective. Pushing through exhaustion without rest can lead to ineffective efforts and longer labor. Holding tension in your jaw, neck, or shoulders prevents effective pushing power.
How long does pushing take for a first-time mom?
For first-time mothers, the pushing phase typically lasts between 30 minutes to 3 hours, with the average being around 1-2 hours. Subsequent births usually have shorter pushing phases, often 15-45 minutes. The duration depends on factors like baby’s position, your pushing technique, whether you have an epidural, and your pelvic shape. Delayed pushing (laboring down) can shorten the active pushing time even for first-time moms. If you’ve been pushing for more than 2 hours without progress, your care provider may suggest interventions or position changes.
Trusting Your Body, Practicing for Confidence
Learning how to push during labor goes far beyond the simplified instructions most childbirth classes provide. The techniques in this guide – open glottis pushing, partner-assisted positions, pelvic floor protection, and mind-body integration – represent the fuller picture of what effective pushing can look like.
The key is practice. Work through the step-by-step pushing instructions while you’re still pregnant. Practice the breathing techniques during your daily routine. Teach your partner the Single Knee Press and Cook’s Counter Pressure techniques so they feel natural when labor begins.
Remember that birth is unpredictable. You might use all of these techniques, or you might find that your body takes over and pushing becomes instinctive. The goal isn’t perfection – it’s preparation. When you understand the mechanics of pushing, you can adapt to whatever your birth brings with confidence rather than confusion.
Your body was designed for this. Trust it, prepare with it, and know that you have more tools than your childbirth class might have suggested.