Directed Pushing vs. Spontaneous Pushing

We’ve all seen it. That birth scene in a movie or TV show where the mom is lying on her back, feet in the stirrups, while a physician tells her to hold her breath and push while they count to 10. It’s called “directed pushing,” and it’s a very common way for women to deliver their babies – especially during hospital births. But directed pushing is not the only – or even the best – way to deliver a baby. According to research, prolonged breath holding can reduce oxygen flow to both the mother and baby, and is not optimal for sustained periods of time. Directed pushing may also increase a woman’s risk of tearing and weakening of pelvic floor muscles.

Another technique to consider is known as “spontaneous pushing.” With spontaneous pushing, a woman’s body guides the pushing phase as she feels the urges. Her body knows intuitively how to push her baby out, and it acts instinctually as it follows and listens to its own signals. This technique may involve more frequent, shorter bursts of pushing, and it also allows for a variety of positions for mom rather than just flat on her back.

If you have an epidural in place and no longer feel an urge to push, sometimes directed pushing becomes necessary. In this case, it is best to “labor down” as much as possible before directed pushing begins. Laboring down means that instead of beginning to push as soon as you’re fully dilated to 10 cm, you wait until baby naturally moves down into a lower and more favorable position. This can take an hour or more, but requires significantly less effort on mom’s part once the pushing begins. It is also helpful to get into as upright position as possible during directed pushing so that gravity can help do some of the work.

Because directed pushing is still very commonly practiced by many providers, it is a good idea to have a conversation with your doctor or midwife prior to labor beginning. Ask them what their standard technique is during the pushing phase and whether or not they are open to allowing you to labor down and push only as you feel the urge to. It is also a good idea to add your preferred pushing technique to your birth plan/preferences (if you have one) so that all the staff and healthcare professionals assisting you are on the same page.

Current recommendations suggest that a mother should pick for herself which pushing technique is preferred and most effective for her. Read here for additional studies on best practices for the second phase of labor: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804305/