Lamaze Healthy Birth Practice: Avoid Giving Birth on Your Back and Follow Your Body's Urges to Push

Adapted from Giving Birth with Confidence, 3rd Edition. 

Many doctors and nurses discourage laboring people from pushing until their cervix is completely dilated and/or encourage them to hold their breath and push as hard as they can without a natural urge once their cervix is fully dilated (called "directed pushing"). There's no research to support these practices. Breath holding without the natural urge to do so is exhausting and deprives a baby of much-needed oxygen. In fact recent research suggests that directed pushing is more stressful for the baby and is associated with increased risk of pelvic-floor problems for the birthing person in the months and years after the birth. It's almost too obvious, isn't it? The signal that it's time to push is feeling the urge to push. If your baby is low in your pelvis, you may feel the urge to push before or at the time of full dilation. Bit if your baby is high in your pelvis at full dilation, you probably won't feel the urge to push until your baby's head moves well down in your pelvis. As your baby moves lower in your pelvis -- especially when your baby's head touches your pelvic-floor muscles (the tissue that forms the floor of your pelvis) -- you'll find yourself involuntarily holding your breath during contractions. You may also naturally grunt and groan during pushing contractions. 

How long will pushing take? As long as it takes. Pushing shouldn't be limited as long as you and your baby are doing well. Like Silly Putty, your perineum takes time and effort to soften and stretch. Once it's soft and stretchy, your baby is easily born. Some caregivers interrupt this process and do an episiotomy (cut the perineum to enlarge the vaginal opening). Research shows that routine episiotomy is harmful. 

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Learn more information about the benefits of upright positions for birth and following your body's urges:

• Read the summary of and complete Lamaze Healthy Birth Practice Paper on avoiding giving birth on your back, available in eight languages, to learn more about healthy pushing practices.
• Learn more about pushing. 
• Watch a video that demonstrates alternatives to giving birth on your back.

Published: May 17, 2023

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