While Stage 2 Labor — the Pushing Stage — gets plenty of attention from Hollywood (as the woman in labor screams furious expletives at her partner), there is actually very little information given to those preparing for this stage in real life.
There are many factors that affect pushing — including timing, position, and technique.
Read on to Learn:
- Pushing Timing: Understand “managed” vs. “instinctive” pushing
- Pushing Position: Understand the position that creates the greatest space in the pelvis
- Pushing Technique: Learn how to prepare your pelvic floor for the unique act of pushing
Pushing Timing
Once the cervix has dilated fully to 10 cm, typically the medical professional will instruct you to begin pushing almost immediately. This is known as managed pushing (or instructed pushing). However, you may not feel quite ready to push just because you are 10 cm dilated. That is because there is often a period of quietude that exists in between Stages 1 & 2 – a phase that does not get attention in traditional medical circles – in which contractions may slow or stop altogether. This happens to allow the baby more time to perform its complex series of cardinal movements so that it is truly ready to be pushed out.
If you can take these quiet moments to breathe deeply, re-center yourself, and prepare physically and mentally for the final “push” (pardon the pun), then the process can be much more efficient. This type of internally derived know-how is called instinctive pushing (or physiologic pushing). All you need to do is listen to your body, then begin pushing only when you feel the uncontrollable urge to do so. Of course, to do this, you need to be in an environment that is supportive of allowing you to take this time. This is why it is so important to find a medical provider (early on) who aligns with your needs and values.
Pushing Position
Now that we’ve discussed when to push, let’s discuss the various positions to push in. The most common birthing position today in a hospital setting is reclining with legs bent and knees in stirrups, like below:
This position enables doctors to have access to see, maneuver, and (if necessary) perform interventions. However, if we take a brief look at how our more “primitive” ancestors gave birth — when they were left to their own devices to do what felt natural for their bodies — the most common positions were standing (supported), squatting, or hands-and-knees because these positions offered the advantage of gravity’s downward pull.
For more information on effective pushing positions, check out this post on Questioning Childbirth Positions. It takes you through a step-by-step process to find the position that creates the greatest space in your pelvis for baby to pass through. You might be quite surprised by what position this actually is!
Pushing Technique
Pushing a baby out requires strength in the deep core along with relaxation of the nervous system to help you recover in between bouts of pushing. This is something you can start preparing for in advance. Practicing 360° Breathing (which we refer to as the #1 most effective core exercise) will help you accomplish both. The myriad of benefits that 360° Breathing offers makes it the most effective exercise for any individual — male and female alike — so the sooner you can start practicing this one, the better.
Once you have a reliable and efficient breathing pattern, it’s time to turn your attention to the floor of your core: your pelvic floor (PF). As you can imagine, this area is going to be very important for a vaginal delivery because the pelvic floor functions as the “exit” door for baby. Your pelvic floor muscles need to stretch so that baby can pass through. The more tension you hold in these muscles, the more work that will be required (by you and your baby) to get the baby out.
Therefore, having good control over your pelvic floor is essential for a smoother delivery.
To help you develop good control of your pelvic floor muscles through a full range of motion, practice the Pelvic Floor Activations (PFAs). The sooner you can begin practicing these, the better.
Once you have mastered PFAs, you should feel a level of familiarity with your deep core system that you didn’t have before. As you get closer to birth (ideally around 28 – 30 weeks), you can begin specific pelvic floor preparation for Stage 2 Labor by using a technique we call Pushing Practice.
Pushing Practice helps you develop the power to push your baby out while “opening the exit door” (your pelvic floor muscles) to allow baby to pass through. It begins much like the PFA-Slow that you learned in the Pelvic Floor Activations. However, as you exhale and draw your navel in, you will open your pelvic floor muscles (instead of contracting them) as if you are trying to urinate or pass gas. You can also visualize a flower opening. Watch the video below for more details.
So, the forceful exhale is what provides the power to push baby out, while the opening of the pelvic floor muscles on the exhale is what provides that easier exit for your baby.
Keep in mind that this is the same “technique” that you can use when having a bowel movement. Because the anus is governed by the pelvic floor muscles, you need to be able to relax and lengthen your pelvic floor in order to open the “exit.” Put another way, bowel movements are a perfect opportunity to perform Pushing Practice! Not only will it help you on the toilet, but it is a way of getting in more “reps” in preparation for labor.
A Note for Cesarean Births
The steps we discussed above are still important to practice even if you have a planned Cesarean. While you will not end up pushing like you would for a vaginal birth, the techniques are incredibly beneficial — especially 360° Breathing and PFAs. These exercises will strengthen your core and pelvic floor to help you withstand the increased stresses of weight gain and other pregnancy changes. They will also help your core be more resilient and heal more quickly in the postpartum period.
Additional Resources
For more information on childbirth, see our articles on What Happens During Labor and How to Prepare for the “Intervals” of Contractions.
One of the very best things you can do to prepare your mind and body for labor is to take a childbirth education class. There are many programs you can choose from — including local ones offered by your hospital or other groups. Of all the programs out there, we love Birthsmarter for their empowering and compassionate approach to all things birth.