Labor & Delivery

Pushing During Labor: The Second Stage

The second stage of labor begins when you're fully dilated (10 cm) and ends with the birth of your baby. Pushing is active work — but with the right guidance, many people find it empowering after the intensity of transition.

How Long Does Pushing Take?

Pushing duration varies widely:

  • First-time parents without epidural: 30 minutes to 2 hours average
  • First-time parents with epidural: Up to 3–4 hours is considered normal with modern guidelines (ACOG 2019)
  • Subsequent births: Often 10–30 minutes, sometimes just a few pushes
  • Key factor: Baby's position greatly affects pushing duration — posterior babies (sunny-side up) take longer

How to Push Effectively

Your nurse or midwife will guide you, but key principles:

  • "Purple pushing" (holding breath for 10 seconds, 3 times per contraction) vs. open-glottis pushing (breathing down through contractions) — research slightly favors open-glottis, ask your provider
  • Use the contraction — push when you feel the urge or when guided
  • Between contractions: rest completely
  • Focus push effort down toward your bottom, not up into your chest
  • Trying to poop is the right sensation — the muscle groups are the same

Positions for Pushing

Position affects pushing efficiency and perineal tearing:

  • Semi-reclined: Most common in hospital; convenient for monitoring
  • Hands and knees: Good for posterior babies, reduces perineal tearing
  • Squatting: Opens the pelvis maximally, gravity-assisted
  • Side-lying: Good if fatigued, reduces tearing
  • Birth stool or birthing bar: Upright, gravity-assisted

Crowning and Delivery

When the baby's head is visible at the vaginal opening (crowning), you may feel an intense burning sensation — the "ring of fire." Your provider may ask you to stop pushing briefly and breathe through this to allow tissues to stretch gradually and reduce tearing. After the head is out, one or two more pushes deliver the shoulders and body.

Frequently Asked Questions

Will I poop during pushing?

Possibly — and it's extremely common. The muscles used for pushing are the same ones used for bowel movements. Hospital staff handle this matter-of-factly and discretely every day. It is a complete non-issue.

What is an episiotomy?

An episiotomy is a surgical cut to enlarge the vaginal opening during delivery. Routine episiotomy is no longer recommended. It's used selectively when tearing appears imminent and a controlled cut would be preferable, or in emergency situations requiring rapid delivery.