Years ago, whenever a laboring woman’s cervix became completely dilated—the whole healthcare team would get excited—“she’s 10!,” “she’s complete!” and “it’s time to push!”
The woman would then be directed to push, push, push, whether she felt the urge or not.

“Take a deep breath, hold it, count to 10, and push downward on your bottom,” all the while staying silent. Family members would join in the cheer, “push, push, push!” But what we know now is that this only increased the risks for tearing, exhaustion and perhaps even put the baby in distress from reduced oxygen while mom held her breath.

Laboring Down

Fast forward and now experts say it’s best to let a woman rest when she’s fully dilated, and let nature and contractions bring baby down until mom feels the urge to push on her own. This is called “laboring down.” Even if you receive an epidural, which can eliminate your ability to feel the need to push, the contractions will move baby along while your health care team guides your pushing, and overall this process results in a lot less pushing and a shorter time of pushing.

Proper Pushing

Your body will send you an uncontrollable urge to push—trust it. This is a sign that the baby has entered the part of the birth canal that signals the urge to push. If your cervix isn’t yet completely dilated, which sometimes does happen and you may be only 6 or 7 centimeters, your nurse may ask you to do gentle pushing to help you work through the sensation. This will help relieve any strain on the cervix, which could result in a cervical tear.
The good news is that you will also breathe through the process, called exhaled pushing. Taking a breath, you’ll let it out slowly as you push. You can even make noises like grunting, most women do. Focus on your bottom when pushing as if you’re having a bowel movement, repeating this process when you feel the need to push until baby is born. Exhaled pushing means baby gets more oxygen during birth and you reduce your risks of tearing.
Patience in birth is a virtue—healthcare providers and families alike need it. After long hours of labor it’s understandable that you’re ready to get baby birthed. But as long as both you and baby are doing fine, why not settle in for a nap, allow nature to take its course, and let baby labor down? Ask your care providers to honor this request. Both you and your newborn will then be more ready for that first embrace, and to start breastfeeding.

Experts say it’s best to rest when you’re fully dilated. Allow nature and contractions to bring baby down until you feel the urge to push. This will result in a lot less pushing.


Joanne Goldbort, PhD, MSN, RN, is an assistant professor in the College of Nursing at Michigan State University and an expert nurse adviser to Healthy Mom&Baby.

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