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Have You Learned How to Push?

You’re pregnant – congratulations! Preparing for the birth of your child is an exciting time. There’s so much to do! It’s time to buy all the cute baby clothes, get the nursery ready, and have your baby shower! You’ve probably also taken or plan to take a birth prep class.

Unfortunately, there is often some vital information missing from many traditional hospital-based birth prep classes. Most of this information is having to deal with your body. One of the biggest pieces of the puzzle that is missing? How to push your baby out! Let me give you the low down.

Your Uterus Pushes Your Baby Out!

You read that right! Your uterus pushes your baby out, NOT your pelvic floor OR your abs. This is what your uterus is meant to do, and we do not have control over what our uterus does. Yes, you will bear down to assist, but it should not be a lot of hard straining. Let’s discuss the few things you have control over during pushing – your position, relaxing your pelvic floor, and bearing down.


Use Gravity to Your Advantage to Push

Traditionally many women labor and deliver on their backs, especially if they have an epidural (I mean that’s how it’s portrayed in all the movies, right?). However, lying on your back does not allow your pelvis (especially your tailbone) to be mobile. It is important that your pelvis can be mobile in order for your baby to pass through.

Use gravity to your advantage to help your baby descend down in your pelvis! These upright positions also allow your pelvis to be much more mobile. Some positions that work great for pushing include hands and knees, squatting, or tall kneeling.

But what if I have an epidural? Just because you have an epidural does NOT mean you have to deliver on your back! Lying on your side holding onto your top leg works great (see picture below). This is the position I gave birth to my second child in! If you have an epidural, you can also be assisted onto your hands and knees while you hold onto the bed, railing, or an exercise ball.

Relaxing Your Pelvic Floor

Next to discuss is your biggest job during labor and delivery – relaxing your pelvic floor! The pelvic floor muscles form the bottom of our core and lie inside of our pelvis. They are responsible for supporting the internal organs and providing sphincter control (so you don’t pee or poop when you don’t want to!). Your pelvic floor muscles need to relax and lengthen up to two to four times their resting length (what other muscle in our body can do that?!) in order for your baby to pass through.

During labor and delivery with my first child, I didn’t know how to relax my pelvic floor nor did I even know that I needed to relax my pelvic floor. Forcefully bearing down into a tight pelvic floor while lying on my back just did not work well for me. Check out this blog post to hear more about my labor and delivery experiences.

Pelvic floor stretches are a great way to prepare your pelvic floor muscles to relax and lengthen for labor and delivery. Below are two great pelvic floor stretches. While holding these stretches, work on taking deep inhales. Additionally, imagery can be super helpful in relaxing those muscles both as you prepare your pelvic floor during pregnancy as well as during labor and delivery. Try picturing your hips widening, your vagina opening like a flower – whatever image works for you.

How to Push

Bearing Down

As I mentioned earlier, your uterus does most of the work to push your baby out. You should bear down to assist, but it should NOT be a lot of hard straining. Let’s start with discussing how to bear down.

Think of your pelvic floor like an A-frame house. At rest, your pelvic floor is on the first floor. When you do a Kegel, your pelvic floor goes up into the attic. When you bear down and push during labor, your pelvic floor goes into the basement. It should feel like you’re pushing a tampon out or like you’re pooping.

Sit with your hand on your perineum (the tissue between your vaginal opening and anus). Gently bear down. Do you feel a downward motion into your hand? This is how bearing down and pushing should feel.

Pushing Strategies

There are two pushing strategies – holding your breath or breathing out as you push. The research out there on which strategy is better (more effective, less tearing, etc.) is unclear. However, anecdotally from myself, other mamas I know, and several other pelvic floor physical therapists, it seems like there may be less tearing and improved ability to relax your pelvic floor if you breathe out as you push. Having an open airway up there you may be more likely to open your sphincters down there. Personally, I also have a much easier time relaxing any muscles if I’m breathing versus if I’m holding my breath.

So, how do I push? When you feel the urge to push during labor, take a big inhale, relax your pelvic floor and picture your hips widening/vagina opening like a flower, and gently bear down as you breathe out. Check out the video below for a pushing tutorial.

Practice How to Push

Practicing pushing helps create muscle memory so your body knows what to do. This can be especially helpful if you have an epidural and don’t have the best sensation of what is going on down there. There are two ways you can practice pushing. Because bearing down during delivery is similar to pooping, you can practice pushing every time you poop within those last few weeks of pregnancy. You can also practice pushing in different positions you may want to try during delivery. You may find that one position works better for you than others!

Get Ready to Push That Baby Out!

I hope this blog post cleared things up for you about how to push during delivery. Give these techniques a try and let us know how it goes! Do you have questions regarding pushing or other ways to prepare for labor and delivery? Check out this blog post about our birth prep sessions or send us a message!

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