Types of Pushing During Labor

When people picture birth, the first image that often comes to mind is someone lying flat on their back in a hospital bed. But that’s only one option, and it’s not always the best one. The way you position yourself, how you push, and even how you breathe can all shape your birth experience. Let’s break down the different approaches, their pros and cons, and what the evidence tells us.

Birth Positions: You Have Options

Even if you have an epidural, you’re not necessarily confined to lying on your back the entire time. With help from your care team, you can often try side-lying positions, especially with the use of a peanut ball. This simple tool helps open the pelvic canal and has been shown to shorten the first stage of labor while increasing the likelihood of a vaginal delivery.

If you’re planning an unmedicated birth, your options open up even more. Upright positions—such as standing, walking, or using a birthing ball—can reduce pain, shorten labor time, and lower rates of assisted delivery. You can sit on the ball, kneel over it, or lean against it for support.

Of course, there are some trade-offs. Upright positions may slightly increase the risk of blood loss and possibly second-degree tears, though the research is mixed. The key takeaway is that movement and position changes can make a meaningful difference, whether you have an epidural or not.

Types of Pushing

It’s worth remembering that the uterus is the muscle doing the real work of contracting and pushing the baby out. Your role is to use your abdominal muscles to increase abdominal pressure and coordinate with those contractions to assist while your pelvic floor relaxes to let the baby move through.

There are two main types of pushing:

• Coached pushing – Common with epidurals, since you may not feel your contractions as clearly. You’ll be guided when to push based on a monitor.

• Spontaneous pushing – You follow your body’s cues, pushing when you feel the urge.

Both methods can be effective, and the best approach often depends on your birth circumstances.

Immediate vs. Delayed Pushing

Once your cervix is fully dilated, you can either push right away (immediate pushing) or wait until you feel ready (delayed pushing, also called “laboring down”).

• Immediate pushing may lead to a shorter second stage of labor and has been linked to lower rates of postpartum bleeding and infection, especially with an epidural.

• Delayed pushing often results in less fatigue, shorter active pushing, and lower rates of instrument-assisted deliveries. Without an epidural, it has also been linked to lower rates of C-section and episiotomy.

There isn’t one “right” option. This is something to talk through with your provider based on your health, your preferences, and how your labor is progressing.

Breathing Strategies

Breathing matters too. There are two main strategies:

• Closed glottis breathing – You take a deep breath, hold it, and bear down, similar to the way you might brace for a heavy lift. It’s powerful and forceful but uses a lot of energy.

• Open glottis breathing – You take a deep breath and exhale audibly (like saying “ahhh” or “ooo”) while pushing. This helps keep your airway open and conserves more energy, making it feel more sustainable.

Closed glottis breathing is often paired with coached pushing, while open glottis is usually paired with spontaneous pushing. However, they aren’t exclusive. In fact, practicing both is helpful, because you never know how your labor will unfold.

Think of it this way: closed glottis breathing is like sprinting, and open glottis breathing is more like running a marathon. Each has its place, and switching between them can be useful depending on the stage of labor.

Takeaway

There’s no one-size-fits-all way to push during labor. Positions, timing, and breathing strategies all come with pros and cons, and what works best for you may change in the moment. The most important thing is to understand your options ahead of time and be ready to adapt. That way, you can feel more confident and supported no matter how your birth unfolds.