A smooth delivery comes down to a combination of physical preparation, the right environment, and smart decisions during labor itself. No birth is entirely predictable, but the choices you make in the weeks before and the hours during labor can meaningfully reduce your chances of tearing, exhaustion, unnecessary interventions, and a longer recovery. Here’s what the evidence supports.
How Stress Slows Labor Down
Understanding one basic piece of biology helps everything else make sense. Your uterus contracts because of oxytocin, a hormone your body releases in pulses during labor. When you feel stressed, afraid, or unsafe, your body shifts into fight-or-flight mode and releases adrenaline and other stress hormones. These directly interfere with oxytocin release, weakening contractions and slowing labor progress. Women with higher anxiety levels during labor have measurably lower oxytocin in their blood, and their labors tend to take longer.
This isn’t just a “try to relax” platitude. It’s the physiological reason why so many of the strategies below work: they either boost oxytocin or reduce the stress hormones that suppress it. A calm, supported, uninterrupted labor environment isn’t a luxury. It’s a biological advantage.
Get Continuous Support During Labor
Having someone dedicated to your emotional and physical comfort throughout labor is one of the most well-studied ways to improve birth outcomes. This can be a doula, a trained birth companion, or even a deeply involved partner, but the key word is continuous. Someone present from start to finish, not checking in periodically.
The numbers are striking. In one large study, women with doula support had a cesarean rate of 13.4% compared to 25% without. For women whose labor was induced, the gap was even wider: 12.5% versus 58.8%. Doula-supported mothers were also less likely to use epidurals or other pain medication (72% versus 83%) and had higher rates of breastfeeding initiation. A separate analysis found doula support was associated with a 52.9% decrease in the risk of cesarean delivery and a 57.5% drop in postpartum depression and anxiety.
What doulas actually do matters too. Physical support (counter-pressure on your back, help changing positions, massage) and informational support (explaining what’s happening, helping you communicate with your care team) were more strongly linked to reduced interventions than emotional support alone.
Move and Stay Upright
Your position during labor, especially during pushing, has a direct effect on how things go. A meta-analysis of over 4,300 women found that upright positions during the second stage (pushing) reduced the rate of instrumental delivery, meaning forceps or vacuum, by 26%. The active pushing phase was also about 8 minutes shorter on average.
Upright doesn’t mean you have to stand the whole time. Kneeling, squatting, sitting on a birth ball, hands-and-knees, or leaning forward over the back of a bed all count. The common thread is working with gravity rather than lying flat on your back, which compresses blood vessels and narrows the pelvic outlet. If you have an epidural, you may have fewer options, but side-lying and supported sitting positions still offer advantages over lying flat.
Let Your Body Guide Your Pushing
There are two approaches to pushing: coached (where someone counts to ten and tells you to hold your breath and bear down) and spontaneous (where you follow your own urge to push in shorter bursts). Spontaneous pushing is generally easier and safer for both you and your baby.
When you push in response to your body’s signals with short periods of breath holding, your baby gets more oxygen through the placenta, you’re less likely to become exhausted, and there’s less trauma to your perineum and pelvic floor muscles. Coached, forceful pushing has been linked to more tearing and weaker pelvic floor muscles months after birth, which can contribute to urinary or fecal incontinence. Birthing the baby slowly between contractions, rather than powering through, also reduces the risk of tears.
If your second stage is unusually difficult or prolonged, directed pushing may help. But as a default starting point, following your body’s cues in a calm, unrushed environment leads to better outcomes.
Prepare Your Perineum
Starting at 35 weeks of pregnancy, daily perineal massage can reduce your risk of significant tearing during delivery. The technique involves gently stretching the tissue between the vaginal opening and the anus, using a natural oil, for about 5 to 10 minutes. Your partner can do this for you or you can do it yourself.
It’s also worth knowing that routine episiotomy (a surgical cut to widen the vaginal opening) is no longer recommended. Both the American College of Obstetricians and Gynecologists and the World Health Organization advise against it for spontaneous vaginal deliveries. A large network meta-analysis found that skipping episiotomy entirely ranked best for outcomes, with lower risks of wound infection, postpartum pain, and anal incontinence compared to routine cutting. When episiotomy is reserved for true emergencies like shoulder dystocia or concerning fetal heart patterns, outcomes are significantly better than when it’s done as a matter of course.
Use Water for Pain Relief
Immersion in warm water during the first stage of labor (before pushing) is one of the most effective non-drug pain strategies available. It reduces the perception of painful contractions, decreases the use of pharmacological pain relief, and increases maternal relaxation and satisfaction. Women who labor in water also tend to feel more empowered and more actively involved in decision-making during their birth.
Many hospitals and birth centers now offer labor tubs. You don’t have to deliver in the water to benefit. Even spending the earlier, more intense hours of active labor submerged can help you cope without medication and keep your body in that calm, oxytocin-friendly state.
Eat and Drink During Labor
Labor is one of the most physically demanding things your body will ever do. Your uterus is one of the largest muscles in the body, and powering its contractions over a labor averaging 9 hours requires between 2,900 and 3,600 kilojoules of energy (roughly 700 to 860 calories). Energy demands climb even higher during pushing, when oxygen consumption jumps by about 40% compared to earlier stages.
When you can’t eat, your body starts breaking down fat for fuel, which produces ketones and can lead to low blood sugar, fatigue, and metabolic stress. This has been linked to longer labor and higher cesarean rates. The World Health Organization has recommended since 1997 that providers respect a woman’s desire to eat and drink during labor. For low-risk women, moderate oral intake does not increase complications and helps maintain energy, stabilize blood sugar, and reduce exhaustion. Carbohydrate-rich drinks, isotonic solutions, and light high-protein snacks are good options. The American Society of Anesthesiologists takes a more cautious stance, recommending clear liquids only, so check your hospital’s policy in advance and discuss your preferences with your provider.
Know the Facts About Induction
If you’re a first-time mother and your pregnancy is low-risk, you may be offered induction at 39 weeks. A landmark trial published in the New England Journal of Medicine, known as the ARRIVE trial, found that elective induction at 39 weeks actually lowered the cesarean rate compared to waiting for labor to start on its own: 18.6% versus 22.2%. This challenges the older assumption that induction automatically raises your chances of a cesarean.
This doesn’t mean induction is right for everyone, and it doesn’t apply to women who’ve had previous vaginal births (the trial studied first-time mothers only). But if your provider suggests it, it’s worth having a conversation grounded in this data rather than assuming induction will make your delivery less smooth.
Putting It All Together
The weeks before your due date are the time to line up your support, practice perineal massage, discuss your preferences with your provider, and familiarize yourself with positions you’d like to try. Pack snacks and drinks for your labor bag. If hiring a doula is an option, the evidence strongly favors it. During labor itself, the throughline is simple: stay nourished, stay moving, stay supported, and let your body do what it already knows how to do. The less your fight-or-flight system is activated, the more efficiently your uterus contracts, the more smoothly your cervix opens, and the more gently your baby arrives.