How To Push- Your Official Guide

(Disclaimer- I am not a medical professional.  My only experience is my own.  Feel free to ignore all I say.)

How do you push a baby out?!  Admit it- you wondered how the second stage of labor worked before you had kids.  I remember women talking about how they didn't know how to push before I had children.  So, HOW DO YOU PUSH OUT A BABY?!

As with anything in childbirth there are rules and opinions on this aspect of the birth process.  One side says,
"Push as hard as you can.  We will stand over you with stop watches and yell at you when you don't push hard enough.  Your eyes should hurt." 
The other side says,
"Don't push.  B  R  E  A  T  H  E  your baby down.  Pushing like this is peaceful and like walking on the ocean.  You want the birth to be peaceful, right?"
 Here is the "Official Guide to Pushing, 1st Edition" by Mama Birth

You are in labor.  You are pushing your baby out.  Don't worry to much about what other people tell you to do, especially if it was in a book, promises it will be pain free, or if what you read is sure there is only one right way to do this. 

(Here is the revolutionary part.) 

Push when and to what degree your BODY TELLS YOU TO PUSH. 

If the urge is undeniable and strong, then do that.

If it is light and easy, do that. 

If it feels better to push, do that. 

If you feel a burning or the "ring of fire" then listen to that.  That is your body telling you to back off.  (See, you didn't need a book, your body KNEW what you needed.)

If you feel like holding your breath helps, then do that, it can give you more power.  If you feel like breathing it out helps, then do that. 

There is no one way to push a baby out just like there is no one way to handle labor sensations or parent a child. 

A few more pointers:

Remember that to be able to FEEL what your body needs to do you must me able to actually feel your body.  This means being unmedicated so that you are in touch with your bodies needs. 

Remember that the idea of purple or directed pushing (where everybody stares at the monitor and tells you what to do and when to do it) is an invention needed only because most women can't actually feel this part of their labor. 

Remember to push down and out your bottom.  Pushing out your face just gives you burst blood vessels and sore eyes.  (Been there, done that.  Nobody tells you that your actual eye balls can get sore from pushing, but it is true.)

Feel like vocalizing?  Great, but, in my experience, sometimes that vocal power can be better harnessed if rather than letting it escape out your mouth you push it out your bottom and use that power to get your baby out.  This is not true for everybody. 

Frequently asked questions:

What is pushing like?  Do women like it? 
This varies from one woman to the next.  Some love to push.  Sometimes it is painless.  For me, I never want to tell people this, but....... It is - freaking out, tear my head off, excruciating, I am pretty sure I am gonna die, kind of pain.  Thus the screaming and the pushing to get it over with.  
But don't be afraid.  It is different for everybody.  Full disclosure.  
 It looks like it really hurts.  Maybe I should get the drugs so I can't feel it.  

Well- remember that it is often painless but just hard work.  You won't know until you are there.  And remember, that if you can't actually feel- you get stuck with purple, directed pushing.  And also- you can't move.  That makes it hard to do the most athletic part of birth, wouldn't you think?

Not to mention that gravity is a good companion when pushing.  Plus, women who are numbed often push for longer or may need more external assistance.  They will not be aware of what their body is trying to tell them.  Don't think of pain as your enemy, think of it as your bodies way of communicating. 
How long does it take?  In the videos it looks real quick!

BWHAHAHAHAHA!  (Note,  I am not laughing at you personally, just at the perception throughout society that this is a super quick process.  It isn't always.) 
Pushing can take anywhere from a few minutes or less to hours.  I have personally pushed for anywhere from four hours (first baby) to one contraction (fourth baby).   Pushing often, but not always, takes less time with each baby.  I have talked to women who have pushed for as long as six hours and still delivered healthy babies vaginally.  Variation is the key. 
My doctor/midwife says that everybody should push in a certain way (on their back, on their side, in the classic or "C" position).  S/he has been doing this a long time, don't they know the best way to push?
Hmmm.  Do you find it disturbing at all that this person has decided before you are even in labor how you need to push your baby out?  To me this is a big red flag.  This is your birth.  This is your body.  This is also your decision.  Somebody who doesn't get that birth is instinctual and mother led, might not really understand birth, despite their degrees. 
The best rule of thumb, listen to your body.  If for some reason that doesn't work (there are always exceptions) then listen to a skilled and kind care provider.  A good care provider will offer advice when you need it and back off when you don't.

Listen to your body. 
The End

I keep trying to write books about birth but they end up being super short, because it is actually pretty simple.  LISTEN TO YOUR BODY.

This is why I am not rich and people who can write 300 pages about this, are. 


AmandaRuth said…
Really feel what your body is trying to tell you.... I agree!

For me, pushing was great. I was happy to see the contractions that were getting to be pretty instense turn into something completely different. I pushed for about 20 minutes. I was on my knees, bent over the couch lol. My body gave me time to relax between each push and it was completely painless (for me at least lol).

It was a little scary when the head was coming out because it seemed to get bigger and bigger - It was so different from my first which was with an epidural and pushing on my back.

Thank you for this post!! You're great!!

My birth story:
Rachel said…
pushing is super intense for me, not my favorite part, but it doesnt last long.

1st - epidural that had been turned off. pushed 30 mins. tore badly.

2nd - natural. pushed about 10-15 mins. forced to push in bed and push fast because they couldnt find heartbeat :( small tear

3rd - waterbirth. pushed 10 mins. no tearing.

4th - waterbirth. pushed 15-20 mins? shoulders were stuck for a bit. 9lbs 11oz. No tearing. He was/is fine :)
Ingrid said…
Um totally love this post! I pushed for 3-3 1/2 hours for my first. When I asked my friend who was a midwife assistant about a recent friend who pushed for 5 hours if that was normal, to my horrifying surprise she said "yes, for some women" haha. If you have never literally witnessed a natural birth, you only see time lapsed or hollywood pushing of babies. And it skews your perception of this part of labor, not to mention so many other parts. haha.
Unknown said…
Fantastic article! For me, the pushing part was a relief! With me my head clears the fog of pain and I become focused on the task at hand. I also know it will be over soon, which gives me energy and a goal to work towards :)
Both of mine were one or two contractions though. Lucky Mumma! I hope any future babies are the same!
Sara said…
So true! For me, pushing was great and a relief. I didn't have a long labor anyway, but pushing was definitely not as bad as I had expected. I think it lasted about 45 minutes, but mostly I was at home and it was pretty sporadic. Noone telling me what to do until we got to the hospital, and then SUDDENLY I need to be told?! The baby is crowning, obviously I figured it out without the experts to direct me.
It boggles my mind to hear quotes from doctors and nurses (my own doctor, no less) telling women to "control" their pushing, and "stop pushing". At a certain point, there is no stopping it. It's a reflex for a reason! The OB that showed up at my daughter's birth noted "patient was unable to control her expulsive efforts". Well, she was crowning when we got to the hospital and was born into my hands and perfectly healthy, so who cares?! I barely tore, so it's not like I was damaging myself. No way I am going to the hospital this time unless there is an emergency.
Lena said…
What a perfect post for me! I am 40 weeks 1 day pregnant today & awaiting my first home water birth. I had a 1st degree tear with my daughter. Hoping to avoid any tears this time.
misidawnrn said…
I love this!!!! I am a Labor & Delivery nurse. I have tried to help my patients do the open glottis pushing. It doesn't work with most of my patients because unfortunately we have a 97% epidural rate and they are heavy epidurals at that. Most of my patients can't feel where, when, and how to push. It is unfortunate that we as a society have become a "no pain, all gain" kind of society and a fast food nation...we want everything timed and want it now. We also have an astronomical induction rate (and the high c/s rate to go with it!!!)
moya said…
Hi! I had a water homebirth 3 years ago and during my pregnancy had guidance from my doula. During my labour (quite fast for a 1st time, about 5h active labour) my doula and midwife kept quiet and allowed me to birth as I thought it should be. I got to a stage I was angry at them "because they weren't doing anything to direct me or speed up things" and I was in so much intense contractions, that I was even afraid to ask if it would take much longer because I was afraid they would say I was only 3cm. At one point I got it togheter and finally thought: hum, I have to do this on my own: it isn't them that are going to birth this baby: it's me. And I focused. However, I got the feeling I should have waited a bit longer to push because I was tired, in pain and no one told me what would happen next so as soon as I felt the ring of fire, I started pushing. I just thought (maybe that was the key mistake: I shouldn't have thought) it was the right time and pushed my eye-balls out (not literally,lol) although I did not feel a specific urge to push. I just wanted to get that burning to stop. Consequently I tore just a bit, and I was always in doubt if I should have waited a bit more are really feel the urge to push, maybe things could have been different. So I was intrigued when I read here: «If you feel a burning or the "ring of fire" then listen to that. That is your body telling you to back off.» What did you mean by this? Can you give me some pointers? thank you!
Sahara said…
Hmm, my experience? I'm one of those women whose providers (a nurse at the time) told me specifically NOT to push when I was feeling the urge. I think it was because I wasn't fully dilated to a 10? It felt like forever trying to ignore and put off that urge, like trying not to pee! It was such a RELIEF to actually push, though now I wish hadn't felt like I needed their "permission" to push, and I intend to do things differently. I don't even remember how long it took because it was like my focus had narrowed down, I was WORKING, dangit! Don't even remember the ring of fire, or feeling the tear, though I do remember it was alot of work, and I'm sure it was painful. Sometimes wonder if I had been better at ignoring the nurses and doctors telling me how to push if I could have avoided the tear since my body was telling me to "breathe the baby out" and since I thought they all knew what I was supposed to be doing, I tried to follow the instructions to hold my breath and push. The more I ponder my experience and learn, the more I realize that even when pushing, birth is very individual to each woman's body and mechanics. Thanks for this article :)
Bipin Kumar said…
I am sad to say that India is also becoming the same. Majority of my patients want a quick-fix remedy.
Tristan said…
Thank you! This post speaks such truth...and besides that, I'm SO relieved to read of someone - after all these birth stories where pushing seems so *easy* or *calm* - who feels that frantic, OMG-I'm-gonna-die-if-this-thing-doesn't-come-out-NOW feeling. I am all about natural birth and how everyone's body tells them something unique, and I never want to forget the feeling of pushing her out, but I couldn't help but feel a little weird that pushing was so NOT calm or pleasant for me. I pushed my baby out in 15 minutes mostly because I could not stop pushing or my head was going to start spinning. I had CHOSEN, however, to push while laying on my back semi-reclined, so maybe that played a big role? Would it have been different if I'd been squatting? I do wonder.
mum2abc said…
Just discovered your blog, (now a midwife), but had 3 babies many moons ago (94, 96,99). My first was an induction for pre-eclampsia at 37 weeks, with an epidural I didn't consent to. I did still feel the urge to push, but wasn't allowed to, due to my escalating BP. However, I did push her out in about 3-4 pushes, especially when they started talking about using forceps to reduce my effort. (she was 2.6kg), an episotomy...
my second was a social induction (my choice), long posterior labour, no drugs and the minute that head hit my pelvic floor, it was again an overwhelming urge and 3 short pushes later, out burst my 4.040 kg big boy at 39 weeks. So quick no one was ready to catch him.
My 3rd I went into labour on my due date and had an awesome labour and didnt really believe I was in labour as I had never done it myself before, however I arrived at hospital at 5cm, the midwife broke my waters half an hour later at 7cms and within 5 minutes I was grunting up on all fours and 2-3 pushes out came my big 4.110 kg boy, again so quickly that the midwife didn't really think it would be that quick, as she wasn't ready to catch him, so just called out, just pick him up, as she was on the other side of the room.
My point is, that once those babies hit my pelvic floor, my body has an overwhelming 'expulsion reflex' and my babies literally burst out.
Ally said…
My first birth was hard, scary but my husband was my rock, and I was lucky enough to have my first baby in a country hospital where not many ladies have babies. She let me do what I felt was natural and made me feel good about what was happening, even when I poo'd she just smiled and said "that's ok don't worry!" When I felt the urge to push she encouraged me to push with my contractions however I felt I should. Half an hour of pushing, no tears! Pushing felt like a relief!

Enter baby number two, born in a city hospital, my labour went really well, I got up, walked around, rocked my hips and breathed through my contractions, my waters broke and I felt the most uncpntrolable urge to bare down! I told them I was pushing, then I was yelled at, told to be quiet while they were talking to me, to stop pushing (yeah right) because they weren't ready, to stop making noise! Needed 2 stitches after that horrible experience!

Baby number three, it was a hard pregnancy, a rush to the hospital after I thought my waters broke but it was blood and a huge clot, I was in hard labor for a couple of hours, was stuck at 3cm dilated, midwife broke my waters, 3 hours later I was 8cm dilated and screaming "I'm pushing!!" I screamed through the pushing, he was out in 4 contractions, no tears! But after baby number two I decided I was going to do what I WANTED TO DO and bugger the midwives!! I happened to have a wonderful midwife though who who when I told her I was pushing she told me to just do what my body wants to do, She was wonderful!

So this sums up all my birth experiences!
dnkdoss said…
My first I had an epidural, episiotomy and vacuum extraction. 4th degree tear. 2 months later, still couldn't sit. 28 weeks preg w/ 2nd. Done lots of research and took Birth Boot Camp ( Natural birthing classes). I'm not going to lie, I am still scared to death, but I feel like I'm stacking the odds in my favor this time. Good to know about the expulsion reflex and the Ring of Fire. Thanks for the article! Very helpful. :-)
Unknown said…
Maria Shriver would be my chosen midwife if I have kids.