While we use it all the time, the phrase 'pushing out a baby' is misleading. During a vaginal birth, it's actually uterine contractions that are largely responsible for moving your baby from your abdomen, through your pelvis, and out of the vaginal canal. These contractions are involuntary, and gradually increase in frequency and intensity as your baby makes its way into the world.
How to best support your body throughout this process, especially as it relates to 'pushing,' is still up for debate. The three most common strategies for pushing during labor include closed glottis pushing, open glottis pushing, and spontaneous pushing. Based on large-scale research reviews, there is no one way to push that's superior for everyone in terms of the health of the baby or birthing parent. The current recommendation regarding how best to push during active labor is to follow the preference of the patient and use the best technique depending on the current clinical scenario.
The truth is that all birthing parents can benefit from becoming familiar with each of these strategies, in the same way it is beneficial to become familiar with cesarean delivery even if you're planning a vaginal birth: It's impossible to predict what might happen during labor and the best anyone can do is prepare!
Keep reading to learn all about the 3 different pushing methods and why practicing pushing can help you feel more confident on the big day.
The 3 Types of Pushing
1. Closed Glottis or So-Called 'Purple Pushing'
This type of pushing, while waning in popularity, is still very common and has historically been used as a means of avoiding instrument-assisted delivery.
Closed glottis pushing involves directed pushing by a healthcare provider to inhale deeply and bear down for a count of 10 seconds, 2-4 times in a row, or throughout the duration of a uterine contraction.
Sometimes referred to as “purple pushing,” the clinical term for this technique is a ‘valsalva maneuver,’ and it’s used to increase pressure and sustain that pressure in your abdomen for an extended duration. While many practices tend to avoid use of the valsalva maneuver, this strategy is still utilized when spontaneous pushing is ineffective, when maternal or fetal safety is compromised, or when analgesia removes the urge for spontaneous pushing.
2. Open Glottis Pushing
This type of pushing is also guided by your provider but does not enlist use of the valsalva maneuver.
Open glottis pushing involves directed pushing by a healthcare provider to bear down for no more than 6-8 seconds and no more than 3 times with each contraction.
The goal is to allow the patient to follow their instincts when pushing, avoid prolonged intense intra-abdominal pressure, and simply use the guidance to time their pushes to be most effective. Often, this is used when analgesia impairs spontaneous pushing urge, when other pushing efforts are ineffective, or when expedited delivery is warranted for health or safety reasons.
3. Spontaneous Pushing
This type of pushing is also considered "delayed" pushing and does not require any intervention or direction from the provider.
Spontaneous pushing involves avoiding any pushing until there is an intense urge to do so or when the baby's head is positioned at the introitus without an urge, as in the case of analgesia use.
This process requires patience from both the birthing parent and provider and demands an ideal, non-emergent clinical situation. This generally leads to 3-5 second pushes for 3-5 times or, potentially, just 1 time along with a peak uterine contraction.
How to Practice Pushing Out a Baby
- The next time you have a bowel movement, practice taking deep breaths towards your abdomen — your pelvic floor should lengthen and your chest should stay still as your belly expands with the inhale.
- If you feel the urge to push, practice doing so by taking a deep breath and gently drawing your belly button in towards your spine as you bear down.
- Hold this pressure for as long as feels necessary (but no more than 10 seconds and ideally less than that) before exhaling, continuing to draw in your belly towards your spine as you exhale.
- And most importantly, practice keeping your pelvic floor relaxed the whole time!
This is a great way to prepare for labor and delivery and often has the added bonus of better, smoother bowel movements without needing to strain.
For additional guidance that is tailored to your specific body, pregnancy and delivery plans, reach out to a pelvic floor physical therapist who specializes in caring for pregnant people and is ready to help you prepare your body for a healthy pregnancy, delivery and recovery.