One of the most nerve-wracking parts of pregnancy is learning about — and preparing for — labour. That's partially because there are so few accurate depictions of labour in media and pop culture. The ones that exist often skip from "is that a contraction?" to "it's time to push!" to a healthy baby. As a result, people may have questions about when and how to push during labour, exactly.
A little helpful background: there are three main "stages" of birth. The first stage includes early and active labour, running from the time contractions begin to when the cervix becomes fully dilated. Active pushing begins in the second stage of labour through the birth. Then, there's the last stage, when the placenta or "afterbirth" is delivered, per Mayo Clinic.
The second stage of labour is often the most active time for the birthing parent — and the time when you need to worry about pushing. Here, two birthing experts go into detail about what to expect, how to push during labour, different breathing techniques for labour that can help, and what to know about how to push during labour without tearing.
How to Push During Labour: When to Push
Pushing should happen after the first stage of labour is fully complete and you've entered the second stage of labour — which means the cervix (the lower end of the uterus that connects to the vagina) should be dilated 10 centimeters, says labour nurse Liesel Teen, BSN, RN and founder of Mommy Labour Nurse. That's a number you've probably heard before. Turns out, there's a very good reason it's so widely cited.
"If you push before your cervix is completely dilated, there's a chance that the pressure of baby's head could actually cause your cervix to swell, which can make it much more difficult to get baby out. If cervical swelling is significant enough it might also impact your ability to have a vaginal birth," Teen says.
What fewer people know, however, is that being fully dilated doesn't necessarily mean it's immediately time to start pushing. "Laboring down" is sometimes necessary.
How to Push During Labour: What Is Laboring Down?
Laboring down means waiting until the baby is lower down in the pelvic or birth canal before pushing. That might take place an hour or more after the cervix is fully dilated.
The best way to know when the baby is down far enough (and therefore when it's time to push) is the amount of pressure you feel, Teen says. Yes, pressure during pushing is not just expected, but a good thing! "Women without epidurals will likely feel a lot of pressure in their vagina and rectum as baby's head gets really low in their pelvis. Some women with epidurals still feel pressure, while others don't feel much," she notes.
The idea behind laboring down is to preserve the parent's energy and shorten the time and energy spent on pushing. "It wouldn't be wrong to start pushing before you feel pressure, but your pushing efforts will be more successful and productive if you're feeling pressure," Teen says. "More productive pushing ideally leads to a short pushing time!"
Teen notes that laboring down isn't appropriate for everyone, though. It also increases total labour time (though it can decrease active pushing time), and carries some risks, including an increased risk of postpartum hemorrhage, reports the Cleveland Clinic. So while it might be the right strategy in some deliveries, it's not necessarily best in all cases.
If you're interested in learning more about laboring down, consider asking your birthing team about their views on the technique before you're in labour so you can all be on the same page.
How to Push During Labour: How to Actually Push
Once your body is ready to start pushing, there are a few techniques that are used, Teen says:
Open glottis pushing. Also referred to as "spontaneous pushing," this method allows the parent to take the lead. "Essentially, you push when you feel the urge. You will probably push for about five seconds, three to five times during each contraction," Teen says.
Guided pushing. "During guided pushing, you'll be guided to hold your breath for six to 10 seconds, bear down like you're pooping, and push about three to four times with each contraction. You might be asked not to make any noise while you push, which helps guide all your energy towards your bottom where you're pushing," Teen says.
Teen says she especially encourages open glottis pushing for those giving birth without an epidural, but both methods are useful and depend greatly on personal preference. It's totally fine to mix and match the two as well, or to just go with what your birthing team suggests in the moment.
For those with an epidural, the main difference in pushing is how the epidural restricts movements and positioning. "This does not mean that you have to push on your back with an epidural, but it does mean that you are, typically, confined to your bed," Teen says. You can, however, consider pushing from your side, hands and knees, or even semi seated.
How to Push During Labour: How Long Does It Take to Push a Baby Out?
The average push time for labour is about two hours, Teen says, though this number can vary based on the individual and how many births they've had before. Many hospitals have limits on how long pregnant people can push before a C-section is recommended; usually around three hours, says Maeva Althaus, doula, childbirth educator, and founder of Hypnodoula Maeva.
For first-time birthing parents, at least three hours should be allowed before a C-section is recommended, and at least two hours for people who've given birth before, according to The American College of Obstetricians and Gynecologists.
How to Push During Labour: Breathing Techniques For Labour
Breathing is also a critical part of labour, Althaus says.
"It is important to take deep breaths in between pushes. The baby's heart rate usually drops when you're pushing and comes back up in between pushes, which is normal. Deep breaths in between contractions does wonders [for parent and baby]," Althaus says.
In a hospital setting where parents are using the guided pushing method, it's sometimes necessary to use an oxygen mask between contractions. For Althaus, who prefers an autonomous birthing approach, she recommends breathing however you want during pushing, as long as you are making sure to take deep breaths and are engageing the core as you breathe.
How to Push During Labour Without Tearing
Tearing during labour is a big source of anxiety for most parents (especially because it often requires stitching), but Teen says it's absolutely possible to push without tearing.
Tearing has very little to do with "proper" pushing, and much more to do with external factors (some of which you can prepare for, and others not so much). "Being a first-time mom is the biggest risk factor for tearing, [and] more than four out of five first-time moms will tear during birth. Over 96 percent of these tears are more minor tears, being first- or second-degree tears," Teen says. Other risk factors for tearing include a baby that's over 8.5 pounds, prolonged pushing, a forceps delivery, and having an episiotomy (an incision made to the perineum during birth).
To prevent tearing, Teen recommends regular perineal massage in the three to four weeks leading up to birth, a warm cloth on the perineum (the area between the vaginal opening and the anus) during pushing, and avoiding a squatting position during birth.
The bottom line is, tearing can't always be avoided, and it isn't a sign that you've done something wrong during labour. The best thing you can focus on is making sure your health and safety, and the health and safety of your baby, are being cared for from start to finish.