Mend Physical Therapy Blog and Injury Information

Recommendations On How To Push During Labor

January 27, 2022

A frequent question of pregnant patients is, “how do I actually push during labor”? If they ask friends, they will often get the answer, “well in the moment you just know what to do”. If they ask the internet, there are even more vague and varied answers. So let’s discuss the best biomechanics and research backed techniques for pushing during labor and delivery.

When delivering a baby, what most don’t realize is that the muscle pushing the baby out is your uterus, not your pelvic floor. Ideally, your pelvic floor needs to get out of the way during birth! This is why a pelvic floor contraction, or a Kegel, is the opposite of what your body needs to do during delivery.

So what does pushing during delivery really mean then? The action should be a pelvic floor drop (think the opposite motion of a pelvic floor contraction) and a transverse abdominis contraction while maintaining that pelvic drop. A transverse abdominis contraction can be achieved by the motion of drawing your belly button down and in toward your spine. Clinically, we see a lot of women that find it challenging to properly engage that transverse abdominis and properly drop their pelvic floor, especially during pregnancy. It is recommended to seek an evaluation by a pelvic physical therapist to ensure you are performing those motions properly and able to coordinate the two correctly. Once you can properly coordinate this push, it is recommended to practice this starting at 30-34 weeks pregnant, and to try it in all positions you intend to labor in (on your back, lying on your side, in all fours position, in a squat, etc. see blog about best birth positions) and try at least 10 a day through the rest of your pregnancy. When in the delivery room, research shows the optimal dosage is three to four pushing efforts of 6-8 seconds in length per contraction.  Realize that receiving an epidural will hinder the ability to feel and control your pelvic floor. Still, a proper push can be achieved by focusing on transverse abdominis engagement and by optimizing breathing.

What is the optimal way to breathe during labor and delivery? Breathing should be altered based on three main phases of your delivery:

During Contractions/Early Labor- focus on big inhales and feel your pelvic floor drop/relax during the inhale. 

While Pushing- as in the mechanism described above, inhale and drop your pelvic floor, then maintain the drop as you exhale and engage your transverse abdominis. Exhale over 6-8 seconds. Relax and reset. Repeat 3-4 per contraction.

Crowning- to minimize tearing, stop active pushing and transition to short half-second breaths/pants. It can help to actually stick out your tongue like a panting dog.

A pelvic physical therapist will help teach you these techniques and more in order to prepare for your most successful childbirth. If you are pregnant, come see a pelvic specialist at MEND in Boulder, CO.

ACOG Committee Opinion . (2019). Approaches to Limit Intervention During Labor and Birth. Obstetrics and Gynecology , 133(2), 164–173.

When and How to Push:  Providing the Most Current Information About Second-Stage Labor to Women During Childbirth Education. Simpson, Kathleen. The Journal of Perinatal Education. 2006; 15(4): 6-9.

Effects of pushing techniques during the second stage of labor: A randomized controlled trial. Koyucu, R., Demirci, N. Taiwanese Journal of Obstetrics & Gynecology. 2017, 56: 606-612.

Lemos A, Amorim MMR, Dornelas de Andrade A, de Souza AI, Cabral Filho J, Correia JB. Pushing/bearing down methods for the second stage of labour. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD009124.