ou've probably heard the advice: take a deep breath, hold it, and push as hard as you can. But is that the only way to push during labor?
When preparing for childbirth, many expecting parents focus on managing contractions, creating a birth plan, and deciding where they want to deliver. But one important part of birth preparation often receives less attention: the pushing stage of labor.
Labor involves more than pushing your baby out. Your uterus contracts, your cervix dilates, your baby rotates and descends through the pelvis, and your pelvic floor muscles stretch to accommodate your baby's passage.
Understanding how these processes work together can help you feel more informed about your options and better prepared to work with your birth team.
At Studio Duyan Physical Therapy + Wellness, we believe prenatal education should include understanding your pelvic floor, exploring birth positions, and learning how to coordinate your breathing and muscles as you prepare for labor.
Understanding the Pushing Stage of Labor
The second stage of labor begins when the cervix is fully dilated and ends with the birth of your baby.
During this stage, your baby continues to descend and rotate through the pelvis. These movements are known as the cardinal movements of labor. They allow your baby to navigate the shape and dimensions of the birth canal.
The process is not simply a matter of pushing your baby straight down. Your baby's head changes position and orientation as it moves through the pelvis, while your uterus continues contracting and your cervix completes the process of opening.
Your pelvic floor also plays an important role. These muscles support your pelvic organs and help coordinate movement through the pelvis. During vaginal birth, the pelvic floor needs to accommodate your baby's descent and stretch as your baby moves through the birth canal.
Because these processes happen together, labor is not always a predictable, step-by-step sequence. Every birth is different, and the experience of pushing can vary from one person to another.
Spontaneous Pushing vs. Directed Pushing
There are different approaches to pushing during labor. Two commonly discussed methods are spontaneous pushing and directed pushing.
What Is Spontaneous Pushing?
Spontaneous pushing occurs when a birthing person follows their body's natural urge to push.
As the baby's head descends deeper into the pelvis, pressure on surrounding structures and nerves can trigger an involuntary pushing reflex. Some people describe this as an intense, instinctive urge to bear down.
When this happens, the body may naturally coordinate abdominal pressure, breathing, and muscular activity without needing someone to count or instruct every push.
In her article, The Anterior Cervical Lip: How to Ruin a Perfectly Good Birth, midwife and childbirth educator Dr. Rachel Reed discusses how the urge to push may occur as the baby's head descends, sometimes even before the cervix has completely finished opening.
Her discussion highlights an important distinction: the urge to push does not always correspond neatly with cervical dilation. In some circumstances, spontaneous pushing before full dilation may occur as part of the physiological process of labor.
This does not mean every early urge to push should be ignored or that every situation should be managed in the same way. Rather, it highlights the importance of individualized assessment, understanding the circumstances of labor, and supporting the birthing person's experience.
What Is Directed Pushing?
Directed pushing occurs when a birth professional provides instructions about when and how to push.
One commonly used technique is the Valsalva maneuver. This involves taking a breath, closing the glottis, holding the breath, and bearing down during a contraction. A person may be encouraged to sustain the effort for several seconds and repeat it throughout the contraction.
Directed pushing can be appropriate in some circumstances, depending on the clinical situation and the needs of the birthing person and baby.
However, it is not necessary for every person to push in exactly the same way.
The American College of Obstetricians and Gynecologists notes that the available evidence does not establish a universally superior technique when comparing spontaneous pushing with Valsalva pushing. It recommends encouraging each woman to use the technique she prefers and finds most effective, taking her circumstances into account.
The key takeaway is that pushing should not automatically be treated as a one-size-fits-all process.
Does Holding Your Breath While Pushing Affect Your Baby?
This is an important question, but the answer requires nuance.
During the Valsalva maneuver, prolonged breath-holding and forceful bearing down can temporarily affect pressure within the chest and changes in circulation. These changes may influence maternal cardiovascular responses during pushing.
However, it would be inaccurate to conclude that every episode of breath-holding causes fetal distress or that directed pushing is inherently unsafe.
Research comparing spontaneous and directed pushing has not established that one technique is best for every birthing person. Outcomes depend on several factors, including the clinical circumstances, the baby's condition, the use of pain medication, and how labor is progressing.
This is why pushing techniques should be considered in context rather than presented as universally safe or harmful.
For expecting parents, the practical lesson is to learn about different pushing approaches before labor, understand your options, and discuss your preferences with your obstetrician or midwife.
Your birth team can help you determine when guidance is needed and how to adapt your approach if the situation changes.
What About Pushing Before the Cervix Is Fully Dilated?
Some birthing people experience a strong urge to push before the cervix has completely dilated.
This can be confusing, particularly if they have been told that pushing should only begin once full dilation is confirmed.
In her article, Dr. Rachel Reed explains that the cervix does not necessarily open in a perfectly circular, uniform pattern. The remaining portion of the cervix may sometimes be positioned in front of the baby's head as the cervix continues to open.
Reed discusses how an early, spontaneous urge to push can occur as the baby descends and may be part of normal labor physiology. She also raises concerns about situations in which a birthing person is instructed to resist an involuntary pushing urge without adequate consideration of the circumstances.
Importantly, the research on pushing before complete dilation is limited. Reed's discussion should be understood as a perspective on physiological birth, not as a universal instruction for every labor.
If you experience a strong urge to push before you have been told you are fully dilated, communicate with your birth team. They can assess the situation and help you determine the safest and most appropriate approach.
You should never feel that you have failed because your body responds differently from what you expected. Labor is a dynamic process, and your care should respond to your individual needs.
How Does the Pelvic Floor Contribute to Pushing?
Your pelvic floor is a group of muscles and connective tissues that support your pelvic organs and help regulate functions such as bladder and bowel control.
During pregnancy, these structures adapt to the changing demands placed on them. During vaginal birth, the pelvic floor needs to lengthen and stretch to accommodate your baby's passage through the birth canal.
This is one reason pelvic floor preparation involves more than strengthening exercises.
Although strengthening may be appropriate for some individuals, others may benefit from learning how to relax their pelvic floor, improve muscular coordination, or recognize when they are unintentionally holding tension.
Being able to contract a muscle is not the same as being able to relax it effectively.
During birth preparation, understanding the relationship between breathing, abdominal pressure, and pelvic floor movement can help you become more familiar with your body.
The goal is not to control every aspect of labor or guarantee a particular birth outcome. It is to develop body awareness and learn strategies that may be useful during the pushing stage.
Can Prenatal Pelvic Floor Physical Therapy Help You Prepare?
Prenatal pelvic floor physical therapy can be a valuable part of birth preparation.
At Studio Duyan Physical Therapy + Wellness, sessions are individualized to your symptoms, needs, pregnancy, and goals.
Depending on your assessment and stage of pregnancy, your physical therapist may help you explore:
1. Breathing and Muscular Coordination
Learn how your breathing, abdominal muscles, and pelvic floor work together. Practice coordinating these systems without unnecessary tension.
2. Pelvic Floor Relaxation
Develop awareness of your pelvic floor and practice relaxing and lengthening these muscles when appropriate.
3. Birth Positions and Movement
Explore different positions and movements that may support comfort, mobility, and your ability to change positions during labor. What feels comfortable can vary from person to person.
4. Body Awareness
Become more familiar with how your body responds to changes in pressure, movement, and muscular effort. This awareness may help you recognize when you are holding tension unnecessarily.
5. Individualized Birth Preparation
Discuss your concerns, previous experiences, physical symptoms, and birth goals. Your physical therapist can help you identify relevant strategies to discuss with your obstetrician or midwife.
Prenatal physical therapy does not replace your obstetric care or guarantee that labor will progress in a particular way. Instead, it can complement your care by helping you prepare physically and better understand your body.
You Don't Have to Figure It All Out During Labor
Birth can be unpredictable. Even with preparation, your experience may look different from what you imagined, and you may need to adapt your approach along the way.
The goal of birth preparation is not to memorize a perfect technique or feel responsible for making labor unfold a certain way.
It is to understand your options, develop confidence in your body, and know that you can ask questions and communicate your needs.
You deserve care that respects your experience, explains your options, and responds to your individual circumstances.
Whether you are preparing for your first baby or building on a previous birth experience, learning about your pelvic floor and the physiology of labor can be a meaningful part of your preparation.
Prepare for Birth With Studio Duyan
At Studio Duyan Physical Therapy + Wellness, we provide individualized, one-on-one physical therapy to support people through pregnancy, birth preparation, and postpartum recovery.
Our prenatal pelvic floor physical therapy sessions can help you better understand your pelvic floor, explore breathing and movement strategies, and prepare for the physical demands of labor.
You don't have to wait until something hurts to prepare your body for birth.
If you are expecting and want to learn more about prenatal pelvic floor physical therapy, we would love to help you explore whether it is right for you.
Book a prenatal physical therapy session with Studio Duyan and take a proactive step toward informed, confident birth preparation.
Studio Duyan Physical Therapy + Wellness is located in Woodland Hills, California.
