Explore the pushing phase of labor, including sensations, effective techniques, positions to try, and tips for comfort during delivery.

Pushing happens in stage 2 of labor. Full cervical dilation opens a passage for the baby to come through. Your pushing will get them through the passage and into the outside world.

Right before you feel the urge to push, you may have a decrease in contractions. Take advantage of this pause and rest. You’ve been through a lot. How long the break lasts depends on where and how big your baby is, as well on if you can push with your contractions.

If this is your first childbirth, the pushing stage may last 1-2 hours and sometimes longer. The stage may last longer if your baby is facing your abdomen (posterior position) instead of your back (anterior position).

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What the urge to push feels like

The urge to push is fairly intuitive, but you may feel more pressure in your lower back, in the area between your vagina and rectum (the perineum), and in your rectum. This could feel like you have to poop.

When the baby’s head crowns and they’re getting close to coming out, there may also be a sensation or stretching or burning.

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Delayed pushing with epidurals

The urge to push can be numbed by an epidural. If that’s the case for you, “laboring down” may be an option. Instead of pushing the baby out, which may be hard to do, you can wait for your baby to start descending through the birth canal on their own. As long as you and your baby aren’t showing signs of distress (lowered or elevated heart rate, temperature, etc.), this is safe to do for 1-2 hours. It may make pushing after that more effective.

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Pushing positions

There are different pushing positions you can try. No matter which one you try, keep your chin down and round your back to engage your abdominal muscles in the process.

The following positions may help speed up the process by taking advantage of gravity:

• Sitting
• Squatting
• Kneeling and leaning forward
• Forward-leaning lunge
• Supported standing or “draping”

The following positions can help slow down the stretching of your perineum during a fast passage by limiting the effects of gravity:

• Lying on your side
• Getting on your hands and knees and lowering your chest
• Sitting semi-reclined
• Side-lying with your top leg supported by your birthing partner
• Semi-kneeling with one knee down and one foot up

Make sure you’re comfortable. You can have your partner or support person hold a towel or sheet or tie one to a squat bar as you’re pushing.

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Tips for pushing

• Save your energy between contractions. Once a contraction comes, give it your all. Pushing in time with contractions gets the baby out.
• Whatever noises you need to get out in order to push effectively, go for it. Grunting or groaning as you push can help you make sure you’re breathing and release some of the pent-up energy.
• Try not to hold your breath unless it helps you push with more power. You need oxygen!

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Stopping the pushing

Your prenatal care provider might ask you to stop actively pushing because the cervix isn’t fully dilated or the perineum is stretching too quickly. Use this time to relax and pant or blow out air (like you’re blowing out candles) during contractions. Pushing can be a really strong reflex, so lean on your support people to help you through it. You can look directly in their eyes to stay focused.

Your comfort and ability to rest matter, so try to focus on that between contractions. Your prenatal care provider will make sure your baby is okay. Know that you can always talk to your provider if you have any questions or concerns.