Pushing Techniques for Birthing

The best pushing technique during labor is unclear and that may be because it’s different for everyone. Current guidelines from the American College of Obstetrics and Gynecology state, “each woman should be encouraged to use her preferred and most effective technique.”

So, what are the techniques?

1. Breath Hold (often coached as “bear down” and often called a “Valsalva” or “closed glottis” push) – This is when you inhale at the start of a contraction and then close your throat so no air escapes as you push. 

2. Breathe Through (often what occurs when no coaching or cues are given and is referred to as “spontaneous” or “open glottis”) – This is when you inhale at the start of a contraction and then exhale as you push. The exhale is often vocal such as a guttural noise, a vibration in the chest, a moan, a shout, a moo.

3. Combo: Perhaps you start with a breath hold and then transition to a breathe through. Or maybe you start with breathing through for some pushes and then as the labor progresses you change strategies. 

   Research has not found a clear difference in outcomes when comparing these techniques, so it is recommended people use their “preferred and most effective technique.” (*See below for more details.)

How do you make the push “effective”?

1. Instincts– Maybe this is a frustrating answer, or maybe it’s a relief. Trust that your body knows how to do this and try not to overthink it.  

2. Positioning– Birthing does not have to be on your back. In fact, current recommendations promote frequent position changes. What position are your instincts telling you to take? What makes you feel strong yet supported? 

3. Understanding where the push is coming from– Your uterus is a muscle. Contractions are the uterus pushing. Think of the push you give as supporting the uterus. You can think about it coming from above and note that the muscles in the pelvis are NOT pushing the baby out. The pelvic floor muscles, the glutes (butt) and the inner thighs must get out of the way. They release to help open the birthing canal. 

4. Rest between contractions. Let your body feel supported. Try some breathing techniques, mantras and positive visualizations. 

   1. Examples: Inhale and release any tensions, exhale and let the pelvic floor melt like butter. Visualize movement through the birthing canal, your cervix blossoming like a flower, or perhaps picture a relaxing calm place. Tell yourself, “my body was designed to do this, I am strong, I am supported, this will bring me joy, each push brings me closer to meeting my baby.”

*A study reviewing 8 research articles comparing spontaneous to Valsalva found no clear differences between the pushing techniques in the duration of the second stage of labor, spontaneous vaginal delivery, episiotomy, perineal lacerations, 5-minute Apgar score less than 7 or neonatal intensive care admissions, or duration of pushing. One study found an increased frequency of abnormal urodynamics (bladder dynamics) 3 months after giving birth in association with Valslava pushing but the long-term clinical significance of this finding is uncertain.

I recommend talking to your provider to discuss how you would like to be supported during labor. If you would like to learn more on this topic, get the Birth Body Workshop or schedule a free consult.

Guidelines taken from:

• The American College of Obstetrics and Gynecology. Approaches to Limit Intervention During Labor and Brith

• Lemos A , Amorim MMR , Dornelas de Andrade A , de Souza AI , Cabral Filho JE , Correia JB . Pushing/bearing down methods for the second stage of labour. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD009124. DOI: 10.1002/14651858.CD009124.pub3 .