Pushing during labor works best when you follow your body’s natural urges, use your breath strategically, and position yourself to give your pelvis as much room as possible. The second stage of labor, the pushing phase, typically lasts up to 3 hours for a first birth and up to 2 hours if you’ve given birth before. While that range is wide, the techniques you use can make a real difference in how efficiently you push, how tired you get, and how your body recovers afterward.
Why Your Body Knows When to Push
As your baby descends and the head presses against your cervix and vaginal wall, nerve signals travel up to your brain and trigger a surge of oxytocin from the pituitary gland. This creates a feedback loop: oxytocin strengthens contractions, which push the baby further down, which triggers even more oxytocin. This is called the Ferguson reflex, and it produces the overwhelming, involuntary urge to bear down that most laboring people describe as impossible to ignore.
That urge is your most reliable guide. The World Health Organization recommends spontaneous pushing, meaning you bear down when your body tells you to rather than on someone else’s countdown. When you push in response to that reflex, you’re working with contractions at their peak force, which is more efficient than trying to time your effort to external coaching.
Two Breathing Approaches
There are two main ways to breathe while pushing, and understanding the difference helps you make a choice that fits your situation.
Closed-glottis pushing (Valsalva maneuver) is the traditional “take a deep breath, hold it, and push for ten seconds” approach. Your care team may coach you through this, counting while you bear down two or three times per contraction. It generates high abdominal pressure quickly, and many providers consider it efficient for moving the baby down.
Open-glottis pushing (spontaneous pushing) means you exhale slowly or vocalize, like a low moan or grunt, while bearing down. You push when you feel the urge rather than on command, and you breathe between efforts within the same contraction. Because you’re not holding your breath, chest pressure stays lower and blood flow to the placenta is better maintained. Some providers prefer this approach because sustained breath-holding can theoretically reduce blood flow to the uterus by raising abdominal pressure above the level of uterine perfusion.
In practice, many people end up using a mix of both. You might start with open-glottis breathing earlier in the pushing stage and shift to more forceful, directed pushing as the baby crowns. Neither method has been shown to cause more tearing than the other, so the best approach is often whichever one helps you push most effectively in the moment.
What Effective Pushing Actually Feels Like
The key physical sensation to aim for is bearing down through your core and pelvic floor, directing force outward and downward. Think of it like a bowel movement, not a crunch. Your abdominal muscles do the work, but your pelvic floor needs to relax and open rather than tighten. This is the opposite of a Kegel. A helpful cue: imagine your sit bones (the bony points you feel when you sit on a hard chair) spreading apart, and your tailbone moving away from your pubic bone.
If you’ve practiced during pregnancy, you may have used a mirror to confirm that the perineum bulges outward and downward when you bear down. If it pulls upward and inward, you’re contracting your pelvic floor instead of releasing it. During labor, your nurse or midwife can give you feedback on whether your effort is going in the right direction. Many people find it helpful to direct their push “into their bottom” rather than into their face, chest, or throat. If you feel pressure in your head, your eyes, or your upper body, you’re likely tensing the wrong muscles.
Resting between contractions matters. You’ll have roughly 60 to 90 seconds of rest between pushes. Use that time to go completely limp, take slow breaths, and conserve energy. Pushing is physically demanding, and pacing yourself prevents the kind of exhaustion that makes later pushes less effective.
Positions That Open Your Pelvis
Your position while pushing changes the physical dimensions of your pelvis. Research using MRI measurements found that a kneeling squat position increases the width of the narrowest part of the pelvis by 1 to 2 centimeters compared to lying flat on your back. That’s a 7 to 15 percent increase in available space for the baby to pass through. The pelvic outlet, the lowest opening the baby moves through, also widens significantly in this position.
Positions that tend to give you more room include:
- Squatting or supported squat: Opens the pelvic outlet to its widest. You can hang from a squat bar on the bed or lean against a partner.
- Hands and knees: Takes pressure off your back, lets your pelvis move freely, and may reduce the severity of tearing.
- Side-lying: A good option when you’re fatigued or have an epidural. It keeps your pelvis asymmetric, which can help a baby rotate into a better position.
- Semi-reclined with knees pulled back: The most common hospital position. It gives your provider a clear view, though it doesn’t open the pelvis as much as upright alternatives.
If one position isn’t working after 20 to 30 minutes, changing positions can shift the baby’s angle and create new progress. You’re not locked into whatever position you start in.
Pushing With an Epidural
An epidural dulls or blocks the Ferguson reflex, which means you may not feel a strong urge to push when the time comes. This is normal and doesn’t mean you can’t push effectively, but it does change the strategy.
A technique called “laboring down” or passive descent means waiting after full dilation and letting contractions move the baby down on their own before you start actively pushing. A meta-analysis of seven studies involving over 2,800 first-time mothers found that this approach increased the chance of a spontaneous vaginal birth, reduced the need for vacuum or forceps delivery by about 23 percent, and shortened active pushing time by roughly 11 minutes. It did not increase the risk of cesarean birth or tearing.
Your care team may suggest waiting 30 minutes to 2 hours after full dilation before starting to push. During this time, you can rest and let gravity and contractions do some of the work. When you do begin pushing, you’ll rely more on coached cues from your nurse or midwife, since the physical sensation guiding you may be muted. Some people can feel pressure but not pain, which gives enough feedback to direct a push. Others feel very little and benefit from placing a hand on their abdomen to feel the contraction peak and time their effort to match.
Slowing Down at Crowning
As the baby’s head stretches the perineum, your provider will likely ask you to ease off or stop pushing and instead let the contraction alone ease the head out. This slow, controlled delivery of the head is one of the most effective ways to reduce tearing. It feels counterintuitive because the urge to push is at its strongest, but short, gentle breaths or panting can help you resist bearing down for those final moments.
Several techniques during this phase help protect the perineum. A warm compress held against the tissue softens it and reduces the severity of tears. Your provider may also use manual perineal support, gently bracing the tissue as the head emerges. Kneeling, hands-and-knees, or side-lying positions are all associated with less severe tearing compared to lying flat on your back.
The head is the widest part. Once it’s delivered, the next push usually brings the shoulders and the rest of the body quickly. For most people, the hardest physical work is done once the head is out.
What Makes Pushing Harder
A few common situations can extend or complicate the pushing stage. A baby facing upward (sunny-side up) puts the widest part of the skull against your spine, which slows descent and increases back pain. Changing positions, especially to hands and knees, can encourage the baby to rotate. Exhaustion from a long first stage of labor makes pushing less effective. If you’ve been in labor for many hours before reaching full dilation, don’t be surprised if pushing feels slow at first.
Tensing your jaw, shoulders, or legs during a push diverts energy away from your core. Between pushes, consciously dropping your shoulders and unclenching your jaw can redirect effort where it’s needed. Some people find it helpful to keep their eyes open and their chin tucked toward their chest, which naturally engages the abdominal muscles more than arching backward.