Options for Pushing During Labor & Delivery

When the time comes to push, most OBs and nurses will call the shots. They will instruct the mother to get on her back on the bed and assist her in holding her legs back. They will likely coach her, telling her when to push, how long to push, and how to push. This kind of directed pushing not only discourages the mother from listening to her own instincts, but it can also increase her fear and anxiety, causing her to lose focus and experience increased pain. Directed pushing can also be straining on mom and baby because mom is holding her breath, not properly getting oxygen to baby, and pushing as hard as she can to forcefully get baby out. The best way to push is by listening to your own body in finding a position that is comfortable. Push with your body, not with someone else’s instruction. Additionally, research has shown that a mother laboring on her back can lengthen labor time and increase the chances for use of forceps, vacuum, as well as many other interventions.

Traditionally moms are told to lay on their back on the bed while pushing. Research has shown that laying on your back is counteractive to the goal you are trying to reach, which is getting baby out. Laying on your back works against gravity as well as the natural reflex a mom has called “Fetal Ejection Reflex.” The Fetal Ejection Reflex is designed to work with your contractions and move baby through the birth canal without having to push. Birthing on your back can also put pressure on your tailbone which creates a smaller and less flexible exit for baby. Upright birthing positions work WITH gravity and your Fetal Expulsion Reflex to gently move baby through the birth canal. Upright birthing positions also provide better oxygen supply to baby and lead to a more positive birth experience.

What if you are planning to get an epidural? There are still options! Even with an epidural and limited movement you can still push in different positions. Different positions during labor, even with an epidural, can shorten the length of the second stage of labor, decrease the chance of needing artificial oxytocin (Pitocin), and lead to fewer episiotomies and greater satisfaction. If you are planning an epidural, you can always ask for a lesser dose of pain medication so when it comes time to push, you can feel all the sensations of pushing without the fear of pain. This encourages mom to listen to her body and not use directed pushing. As with any decision during your pregnancy, you must weigh the risks and benefits yourself. Push positions are also a great topic to bring up to your OB/GYN or midwife, so they have a heads up on your labor plan. Your OB/GYN or midwife should be very open to your wishes during labor. Keep in mind some positions might not be recommended for everyone.

If you are wanting more control during your labor and want to try different push positions, here is a list of different positions you can try:

Standing: your partner or doula should be supporting some of your body weight and your hands should be wrapped around the base of their neck. Standing allows mom to lean forward or sway her pelvis to help baby rotate.

Kneeling: in this position, your partner or doula can provide light massage, counterpressure, or other comfort measures. Kneeling also allows mom to lean forward, sway, or tilt pelvis to help baby rotate.

Lunging/raising one leg: lunging on a chair, on the ground, or kneeling on one leg stretches the pelvis open on one side more than the other. Switching legs after a few minutes will help baby engage into the pelvis and through the birth canal. This position is also great for malpositioned babies. Opening one side of the pelvis more than the other can get baby to rotate into the correct position for delivery.

Squatting: squatting should always be supported by your partner or doula, or someone should be close by in case mom’s legs get tired. This can also be done on the bed with a squat bar to provide more comfort. Squatting helps open the bottom of the pelvis and creates an optimal birth environment. Mom should always lean back and rest in between contractions when squatting.

Side-lying: This position is ideal for moms who want an epidural. This is also a great option for mom to rest during labor but continue to make progress. Your partner or doula should support mom’s leg and support her back to keep her from rolling over.

Semi-sitting: This position is different than supine because it uses more gravity. A partner can support you by sitting behind you and holding your body weight. You can also maneuver the bed in a hospital to a more upright position. This position can put pressure on the tailbone and push it inward.

All these positions work with gravity and your body’s ability to birth without intervention. These positions can also be modified to best fit mom’s comfort needs. If you want to know more about push positions or have any questions, we are here to support your decisions and guide you every step of the way!