How to Push During Labor and Delivery

In my childbirth classes, on the night we talk about how to push during labor and delivery, these fantastic pushing questions come up almost every single time.

• How do I know when to push?
• What if I don’t feel the urge to push?
• How long will it take to push out my baby?
• Can I push without pooping?
• How can I push without tearing?
• How can I push through the pain?

Since everybody is discussing them in class, let’s discuss them here too, shall we?

How to Push During Labor and Delivery

Before we discuss the ins and outs of how to push during labor, let’s spend a moment reviewing the three stages of labor.

Stage 1: Labor and Dilation

Stage 2: Pushing and Birth of the Baby

Stage 3: Delivery of the Placenta

(To read more about the stages of labor and how to cope through it all, check out my post The Doula’s Guide to the Stages of Labor.)

How do you know when to push?

The first question is how do you know when to push? Well, there are a few answers to this question.

The easiest answer is that you push when your body just does it. I know that’s not too helpful for those who are pregnant and never pushed out a baby before, but pushing can be compared to a sneeze or vomiting reflex.

Pushing is an involuntary response. It can actually be hard to NOT push, when your body is pushing.

If you are unmedicated and feeling the urge to push, it is likely time to push. Often at this point a woman may agree to a cervical exam to ensure she is fully dilated (10 cm). If she isn’t 10 cm she may be asked to pant, blow, and/or change positions to push less or possibly stop pushing (which is likely impossible).

How do you know when to push with an epidural?

On the other hand, if a woman has an epidural, she will not feel the urge to push. In this case, she will know when to push when her nurse or doc says so.

However, even with an epidural, many women know that something has changed when they begin to feel a ton of pressure in their pelvis.

A lot of times with an epidural birth nurses will let the mom “labor down” before beginning the pushing stage. Basically, this means they are letting the baby come down on its own without pushing (after a mom is fully dilated).

Since it usually takes a lot longer to push out your baby with an epidural, “laboring down” helps your body do some of the early work so you don’t have to.

What if you don’t feel the urge to push?

If you have had a vaginal exam, are 10 cm but don’t feel like pushing or bearing down, what’s a gal to do?

If something isn’t working, try something new!

One of the first things to try to bring on the urge to push is to change positions. If you have been lying down, try standing up, squatting, getting into the tub, walking, hoolahooping, lunges, etc.

You could also try sitting on a birthing ball. The pressure from the ball could make that urge to push happen quite quickly!

If after trying some position changes and you still feel no urge to push, you could just do nothing. When mom and baby are fine it’s ok to just try to rest and take a break before the big finale. Not feeling the urge to push in and of itself is not an problem or emergency.

If you are over it and ready to see your baby try bearing down a little and see how that feels. Sometimes women don’t feel an overwhelming urge to push and bearing down a little during contractions help. This tiny push may spur on the urge to push and you will be well on your way to baby.

(Someone who was in one of my classes said that with her last baby she never felt the urge to push, but she decided to push anyways and her baby practically fell out. lol!)

How long will it take to push out my baby?

How long does it take to push out a baby anyways? Let’s see… my vaginal crystal ball says 30 minutes. Oh, wait… 90 minutes. I mean 180 minutes. Honestly, nobody knows how long it will take you to push out your baby.

For a first time mom, the pushing stage may take around 1.5 hours. However, for some women they may give birth faster or slower than the average.

Expect pushing to take awhile!

How long will it take to push out my baby with an epidural?

If a first time mom has an epidural the range of normal is even longer. She could be pushing for 4-5 hours (or even more). ACOG supports first time moms with epidurals to push up to seven hours, assuming mom and baby are healthy. It could be awhile!

On the other hand, two women in one of my recent childbirth classes took about 30 minutes to push out their first babies. So, your guess is as good as mine.

TIP:  To speed up the pushing process try an upright position and make sure you’re off your back!

In the above photo I am pushing my first child out. I had to push with everything I had! I was a bit surpriised at how much work it was. It took me 2.5 hours with my first.

With my second and third, (see the three photos below) however, I pushed them out in a matter of minutes. It was shockingly different. They came so quickly!

Can I push without pooping?

Will you poop in front of everybody? Possibly. Probably. 😉

If you have ever looked at the anatomy of a pregnant woman you can see that to push your baby out, your baby’s head will be pushing EVERYTHING that’s there, out.

But get this. When I see poop during the pushing phase at birth I get excited because I know she is pushing correctly and making great progress!

To birth professionals, pooping during pushing a no big deal type of thing (and even celebrated!), but to a pregnant mom this might be giving you nightmares.

TIP:  If you’re wanting to push without pooping, use an enema in the early stages of labor (with the guidance of your care provider) to clean yourself out.

TIP:  If you’re unsure of what the early stages of labor looks like, head on over here.

(Let’s Talk More About Pooping)

What would this mean to you if that happened? What would you tell yourself about yourself?

Think about that for a moment. What would your I AM statement be if you pooped when you pushed out your baby?

I AM _____________.

Now, take another moment and think about if that I am statement is serving you. No? I didn’t think so!

Ok, then what would you like to tell yourself about yourself if you were working really hard, pushing with all you had, bringing your baby down and you pooped.

I AM _____________.

See if you could look at this potential situation with new eyes, eyes of love and acceptance.

How Can I Push Without Tearing?

There are many things that can prevent tearing at birth. Unfortunately, many of these techniques are not practiced in most birth settings. Instead, common mistakes are made that actually don’t prevent tearing.

Here are a few helpful ideas to get you started.

• Use warm compresses on the perineum when baby begins to crown
• Do not use perineal massage during the pushing stage
• Care providers should use a “hands poised” instead of “hands on” approach
• Use pushing positions where pressure is off the sacrum
• Avoid the squatting position unless squatting is part of daily life
• Relax the mind and body throughout the pushing stage

Head on over here to read a popular article about how to prevent tearing at birth.

Want more? Here’s a follow up article about preventing tearing with even more ideas!

How can I push with labor pain?

Many women want to know how to push through the pain of pushing when having an unmedicated childbirth. I’ve got some good news for you!

After transition, one of the most difficult parts of labor, many women report their experience becoming easier. Not only do contractions sometimes space out during the pushing phase, but women typically are able to cope through the pain of contractions better as well.

Because contractions sometimes space out a tiny bit during the pushing phase, women have more opportunity to rest, relax, and even sleep between pushing contractions. This helps tremendously when coping through labor unmedicated.

Also, because women are now able to “do something (push) with their contractions” instead of just experiencing them, women typically prefer pushing compared to other parts of labor like transition.

Of course, women will continue to benefit from using breathing techniques throughout labor on into the pushing stage. Especially for those that are unmediated, it’s often best to let a woman breath and push spontaneously and naturally to maximize oxygen for mom and baby. Oxygen is wonderful! 😉

How to Push During Labor and Delivery

To recap, these are the questions answered in this blog post.

• How do I know when to push?
• What if I don’t feel the urge to push?
• How long will it take to push out my baby?
• Will I poop in front of everybody?
• How can I push without tearing?
• How can I push through the pain?

What About You?

Now that you’ve read this post, what new questions do you have about how to push during labor and delivery? What mistakes did you avoid during pushing?

Let me know what you think by leaving a comment.