If you’re wondering how to push during labor, you’ve probably heard some version of “push like you’re having a bowel movement.”
If you’re pregnant, there’s a good chance you’ve heard some version of this advice.
And while there is some truth to it, there is a lot more happening during pushing than simply “pushing harder.”
Your baby is moving through the pelvis. Your uterus is contracting. Your diaphragm and abdominal muscles are creating pressure. And your pelvic floor muscles, which spent much of pregnancy supporting your growing baby, now need to lengthen and make room for your baby to pass through.
Most women spend months preparing for pregnancy, researching car seats, buying tiny clothes, and getting the nursery ready. But surprisingly few are taught what their body actually needs to do during the second stage of labor.
That is where birth preparation can make a difference.
Understanding how pushing works, practicing different positions, and learning how to coordinate your breath and pelvic floor can help you feel more prepared for the experience—even if your birth does not go exactly according to plan.
How Do You Push During Labor?
Pushing during labor involves creating downward pressure with your diaphragm and abdominal muscles while allowing the pelvic floor to lengthen and make room for your baby to descend. The goal isn’t simply to push harder, but to coordinate your breathing, abdominal pressure, pelvic floor, and position.
What Actually Happens When You Push During Labor?
Once your cervix is fully dilated, your baby begins the process of moving through the birth canal. This is called the second stage of labor.
Think of it as a coordinated effort between several systems:
- Your uterus contracts and helps move the baby downward.
- Your diaphragm and abdominal muscles contribute to pressure within your abdomen.
- Your pelvic floor muscles lengthen and stretch as the baby’s head moves through the pelvis.
- Your body changes position and makes subtle adjustments to help the baby descend and rotate.
This is why pushing is not simply about generating as much force as possible.
More force does not necessarily mean better pushing.
The goal is coordinated pressure and movement. You want your abdominal pressure and bearing-down effort to work with the downward movement of your baby while allowing the pelvic floor to lengthen.
American College of Obstetricians & Gynecologists (ACOG) recommends beginning pushing once complete cervical dilation has been reached and emphasizes an individualized approach to the second stage of labor, particularly when pushing takes longer than expected.
Your pelvic floor has a very different job during birth than it does during everyday life.
During pregnancy, your pelvic floor helps support your uterus, bladder, bowel, and other pelvic organs.
During vaginal birth, those muscles need to stretch significantly.
That doesn’t mean your pelvic floor needs to be completely inactive. Instead, it needs to be able to transition from supporting and lifting to lengthening and allowing movement.
This ability to change gears is an important part of pelvic floor function.
Should You Push With Your Pelvic Floor Tight or Relaxed?
This is one of the biggest misconceptions I hear about pelvic floor function.
You may have spent years being told to “tighten your pelvic floor” or “do your Kegels.” But childbirth requires something different.
Your pelvic floor needs to be able to contract when appropriate and relax when appropriate.
During pushing, the pelvic floor needs to lengthen as the baby’s head moves downward.
Imagine trying to push a balloon through a small opening. If the muscles surrounding the opening are actively squeezing shut, you’re working against yourself.
This is why birth preparation should not simply teach you how to “push harder.”
It should teach you how to recognize the difference between:
Bearing down:
Creating downward pressure using your abdomen and diaphragm.
Bracing:
Holding tension throughout your abdomen, pelvic floor, buttocks, or other muscles without allowing movement.
Pelvic floor lengthening:
Allowing the muscles around the vaginal opening to soften and expand as the baby descends.
The goal isn’t to consciously force your pelvic floor to “open.” In labor, hormones, pressure, contractions, positioning, and your baby’s movement all contribute to this process.
But learning what pelvic floor relaxation and lengthening feel like before labor can give you another tool to draw upon.
What Are the Best Positions for Pushing During Labor?
The important point is this:
You don’t need to commit to one position ahead of time.
ACOG recommends supporting frequent position changes during labor when appropriate, both for maternal comfort and to promote optimal fetal positioning.
Your body may tell you something different in the moment than you expected during pregnancy.
Can You Practice Pushing Before Labor? What Birth Preparation Actually Involves
Yes—but probably not in the way you’re imagining.
You don’t need to practice trying to push a baby out before your baby is ready.
Instead, birth preparation is about practicing coordination.
You can learn:
- How to breathe while bearing down
- What pelvic floor relaxation feels like
- How to recognize unnecessary tension
- How different pushing positions feel
- How to move between positions
- How to use your diaphragm and abdominal muscles
- How your partner can physically support you
- How to communicate your preferences to your birth team
This is one reason I encourage expecting parents to practice before labor.
When you’re experiencing strong contractions, fatigue, excitement, and possibly an epidural or other interventions, it may be difficult to learn an entirely new skill from scratch.
You don’t need to memorize a complicated technique.
You simply want to have some experience connecting your breath, movement, and pelvic floor.
How to Push During Labor With an Epidural
This is an important question because an epidural can change the experience of pushing.
With an epidural, you may have less sensation in your pelvis and legs. You may not feel the same strong urge to push that someone without an epidural experiences.
That doesn’t mean you can’t push effectively.
Your medical team may provide more directed coaching, and your ability to change positions may depend on the strength of your epidural, your hospital’s policies, and whether you have adequate motor control.
This is another reason to learn multiple positions before labor.
You may still be able to use:
- Side-lying
- Supported kneeling
- Semi-reclined positions
- Supported sitting
- Other positions recommended by your care team
ACOG recommends neuraxial anesthesia as an option for pain relief during any stage of labor, and its current guidance recognizes that epidural use can affect the duration and management of the second stage.
An epidural doesn’t mean you have to abandon your birth preparation.
It simply means you may need to adapt it.
How Can Your Birth Partner Help During Labor?
Your birth partner doesn’t need to become your personal labor coach.
In fact, one of the most helpful things a partner can do is support rather than direct.
Your partner can:
Help with positioning
They can help you get comfortable, support your legs, hold a birth ball, or provide physical stability during position changes.
Remind you to breathe
Especially when you’re concentrating intensely, a calm reminder to breathe and release unnecessary tension can be helpful.
Provide physical support
Counter-pressure, hip support, hand-holding, or simply helping you maintain a position can make a significant difference.
Communicate your preferences
If you’ve already discussed your birth preferences, your partner can help remind the care team of them when you’re focused on labor.
Encourage you
Sometimes the most useful thing your partner can say is simply:
“You’re doing exactly what you need to do. I’m right here.”
Your birth partner doesn’t need to know every medical detail.
They need to know how you want to be supported.
How Can You Reduce the Risk of Perineal Tears?
The perineum—the area between the vagina and anus—needs to stretch substantially during vaginal birth.
Some tearing is common, and unfortunately, there is no strategy that can guarantee an intact perineum.
However, several approaches may help reduce the risk or severity of perineal trauma.
Depending on your preferences and your birth setting, these may include:
Warm compresses: Warm packs applied to the perineum during the second stage have evidence supporting a reduction in severe perineal tears.
Perineal massage: Perineal massage can increase the likelihood of an intact perineum and may reduce serious tears.
Position changes: Upright, side-lying, kneeling, and other positions may provide different amounts of pressure and mobility through the pelvis.
Controlled delivery of the baby’s head: Your provider may encourage you to slow down or temporarily pause pushing as the baby’s head crowns.
The World Health Organization recommends perineal massage, warm compresses, and hands-on guarding of the perineum based on the birthing person’s preferences and available options.
And one important clarification: you don’t have to choose one “perfect” perineal protection strategy.
Ask your provider what they typically use and what options are available at your birth location.
What If My Birth Doesn’t Go According to Plan?
This may be the most important part of birth preparation.
Learning about pushing does not guarantee a vaginal birth.
Practicing pelvic floor relaxation does not guarantee that you won’t tear.
Learning different positions does not guarantee that you will be able to use them.
And preparing for labor does not mean that you have failed if you ultimately need an assisted vaginal birth or cesarean birth.
Birth is unpredictable.
Sometimes a baby needs to be delivered quickly. Sometimes labor stalls. Sometimes the baby’s position makes vaginal delivery more difficult. Sometimes a cesarean is the safest option for parent or baby.
Birth preparation isn’t about guaranteeing a particular outcome.
It’s about understanding your body, knowing your options, communicating with your care team, and feeling prepared to participate in decisions—even when your birth takes an unexpected turn.
That is empowerment.
Birth Preparation Starts Before You’re in the Delivery Room
You don’t need to wait until you’re in labor to start thinking about how your pelvic floor will function during birth.
Understanding the difference between tightening and lengthening, practicing different positions, coordinating your breath, and learning how to work with your body can help you feel more confident heading into labor.
And perhaps most importantly, birth preparation can help you replace the vague instruction to “just push” with a better understanding of what your body is actually doing.
Frequently Asked Questions About Pushing During Labor
How do you know when to push during labor?
Most people begin pushing once the cervix is fully dilated to 10 centimeters. You may feel a strong urge to push as your baby moves lower into the pelvis, although this sensation can vary—especially if you have an epidural. Your healthcare team can help guide you based on your baby’s position, your contractions, and your individual circumstances.
Should you push during contractions or between contractions?
Pushing is generally done during contractions because the uterus is already working to move the baby downward. Your care team may guide you to push with the contraction and rest or breathe between contractions. Depending on your situation, you may also be encouraged to follow your body’s natural urge to push rather than holding your breath and pushing forcefully for a set amount of time.
Should your pelvic floor be relaxed while pushing?
Your pelvic floor needs to be able to lengthen and make room for your baby to descend during pushing. This doesn’t mean your pelvic floor has to be completely inactive. Instead, the muscles need to be capable of releasing unnecessary tension and adapting as your baby’s head moves through the pelvis. Learning what pelvic floor relaxation and lengthening feel like before labor can help you recognize and practice this coordination.
What is the best position for pushing during labor?
There isn’t one best pushing position for everyone. Depending on your medical circumstances, epidural, monitoring, baby’s position, and what feels comfortable, you may be able to push in side-lying, hands-and-knees, kneeling, squatting, standing, supported sitting, or semi-reclined positions. Changing positions during labor can provide different amounts of support, movement, and pressure through the pelvis. Talk with your healthcare team about which options are available to you.
Can you push effectively with an epidural?
Yes. An epidural does not mean you cannot push effectively. However, it can reduce sensation in your pelvis and legs, which may make it harder to feel the natural urge to push. Your healthcare team may provide more directed coaching and help you find positions that are safe and comfortable based on your level of sensation and motor control. Learning several pushing positions before labor can help you feel more prepared to adapt if you choose an epidural.
Can pelvic floor physical therapy help prepare you for birth?
Yes. Pelvic floor physical therapy during pregnancy can help you understand how your pelvic floor functions and learn how to contract, relax, and lengthen the muscles when appropriate. A pelvic health physical therapist can also help you practice breathing and bearing down, explore different labor positions, address pregnancy-related pelvic or hip pain, and prepare you and your birth partner for labor. Birth preparation isn’t about guaranteeing a specific outcome—it is about giving you more knowledge, awareness, and tools to adapt during labor.
Want to Practice Before You’re in the Delivery Room?
Reading about birth positions and pushing techniques can help you understand what to expect—but knowing what to do and actually practicing it are two different things.
At Soma Vita Physio & Wellness in Watchung, NJ, our 3-hour Birth Prep Class gives expecting parents hands-on education and practice with pelvic floor awareness, pushing techniques, breathing, positioning, partner support, and other practical strategies for labor and birth.
The goal isn’t to create a rigid birth plan.
It’s to help you feel informed, prepared, and confident in your ability to adapt.
Birth preparation is about more than getting ready for labor. It’s about learning how to work with your body.
3-Hour Birth Prep Class | $249 (come alone)/ $299 per couple
If you’re expecting and looking for pelvic health physical therapy in Watchung, NJ or Central New Jersey, we’d love to help you prepare for pregnancy, birth, and postpartum recovery.
Schedule your consultation or learn more about our Birth Prep Class at Soma Vita Physio & Wellness
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References & Further Reading
- American College of Obstetricians and Gynecologists. First and Second Stage Labor Management. Clinical Practice Guideline No. 8. Obstetrics & Gynecology. 2024.
- American College of Obstetricians and Gynecologists. Approaches to Limit Intervention During Labor and Birth. Committee Opinion. Guidance regarding pushing techniques, position changes, and individualized labor care.
- World Health Organization. WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience. 2018. Recommendations regarding maternal positioning, pushing, and prevention of perineal trauma.
