Techniques for pushing and birth

Wait to start pushing until you feel the urge to push or until your health care provider asks you to push.

Sometimes your body will rest after your cervix is fully dilated. This resting phase may last several minutes to several hours.

Your health care team will help determine if it is safe to wait.

Giving birth: Managing pain video series

This series of five videos covers vaginal birth preparation, pain relief, coping with labor, and recovering in the hospital and at home.

Read a transcript of each video below.

The birth of your baby is an exciting time. Although there is some discomfort involved in any childbirth, your health care team will be with you through each stage of your delivery, answering any questions you may have, and helping you feel as comfortable as possible.

However, there are still many things you can do to prepare for your baby’s birth and hospital stay. This video will focus on the different ways you can take a more active role in your birth, and help ease any discomforts you may feel after giving birth. Mothers who take an active role in their birth and recovery often heal more quickly.

Having a baby is not just about your body. Yes, your body changes during pregnancy, but pregnancy also affects your emotions, and how you feel and care for yourself. This is why preparing yourself physically and emotionally is so important. The birth of your baby is a journey of body, mind, and spirit.

Taking care of your body is the first step. This means making sure you get plenty of rest, which is sometimes difficult during pregnancy.

Sleeping on your side instead of your back is sometimes helpful.

You may also try supporting your stomach with pillows while you sleep.

Try to drink fluids earlier in the day instead of near bedtime.

Eating the right foods is also very important. Avoid foods that may give you heartburn, which makes sleeping difficult.

Make sure you keep all appointments with your doctor – who can also give you information about the best foods to eat while you are pregnant.

It is also important to get some exercise; talk to your doctor about what is right for you. Exercise helps to increase blood flow and supply oxygen to your baby. Getting regular exercise during the day also helps expectant mothers sleep better at night.

Learning how to position your body to ease discomfort during labor is very important. You can practice these techniques by yourself or with a birthing partner or friend – long before you go into labor and need to go to the hospital. These body positions are explained in greater detail in print materials, which can be downloaded by visiting the website mentioned at the end of this video.

A busy mind is common during pregnancy, as expectant mothers often feel overwhelmed.

Writing down any questions or concerns you have is a good way to communicate with your health care team during scheduled appointments. Having information about your birth plan is a good way to put your mind at ease.

The mind and body are linked together. Sometimes your mind feels fear, and it affects your body – sometimes causing physical discomfort. But there are several relaxation techniques you can learn which will allow you to move past fear and put your mind and body at rest. These techniques will be very useful in easing anxiety before delivery, or helping to lessen pain as you recover.

Some forms of relaxation you may already know, such as reading, taking a bath, watching TV, listening to music, and talking with family and friends. These are all very helpful, and you may use these forms of relaxation as you prepare for birth and recovery.

Some other forms of relaxation may be new to you, and you should become familiar with them. Just as an athlete trains for a race, you should prepare for your birth and recovery by practicing these mind-body skills long before you ever go into labor.

The following are brief explanations of these techniques, but they are also explained in greater detail in print and audio files, which you can download by visiting the website mentioned at the end of this video.

We all breathe, but we are not always aware of it. Becoming aware of your breathing and learning different ways to breathe can help reduce your heart rate, increase your oxygen flow, calm your fears, and change how you feel pain. Focusing on your breathing can help you shift your concentration from discomfort to something more pleasant.

Guided imagery is the act of closing your eyes and imagining yourself in another positive place. Guided imagery can be done with words from another person or with music, but you can also imagine this positive place in silence. The relaxing effect of guided imagery is often a sense of calm and peacefulness, which can create a sense of comfort.

Sometimes the simple act of a soft touch can be very soothing, such as the stroking of hair or the forehead. Massaging the hands, feet, and shoulders are also good ways to relieve emotional tension and anxiety, and to create comfort. As you prepare for your baby’s birth, practice massage with your birthing partner or a family member. Massage can be a very good way to ease pain.

Every Allina Health hospital offers aromatherapy, which is the breathing of essential oils to help reduce pain and anxiety, and relax a busy mind. There are many different oils available, and each one offers a different calming effect.

All of these mind-body skills – as well as the body positioning techniques discussed earlier – can be studied in much greater detail by downloading print material or MP3 audio files by visiting the website shown on the screen. If you do not have a computer, your local library can help you download this information.

Allina Health is providing you with these materials to help support you during your pregnancy, the birth of your child, and your recovery. But you can actively prepare for your delivery by practicing these techniques by yourself or with a birthing partner or friend – using all of your body, mind, and spirit.

During your labor, you’ll have different pain relief options available to you. These options may change depending upon your medical condition.

During a normal vaginal delivery, one simple option is to administer pain medication through your IV. The IV pain medication may be enough to lessen the pain as you go through the first and second stages of labor.

There are times, however, when you will feel that more pain relief is needed than what you’re getting from the IV pain medication. In these cases, a procedural called an epidural can be done. An epidural is a procedure where a small tube will be placed through the skin of your back using a needle. The needle’s then removed, and special pain medicine’s given through that tube to provide you with a higher level of pain relief. This medicine’s typically delivered right up until the baby is delivered.

Even if you want to give birth vaginally, there are times when it may be necessary for your obstetrician to recommend delivery by Cesarean section. If you already have an epidural in place, this will most likely be used to give you additional medicine so you don’t feel any pain during the surgery.

If you’re scheduled for a Cesarean birth in advance, or a Cesarean birth is recommended while you’re in labor but you don’t have an epidural in, you’ll most likely receive spinal anesthesia. Spinal anesthesia’s an injection of medicine through the skin of your lower back. This medicine will make the lower part of your body numb, temporarily, so you don’t feel any pain during the surgery.

There are rare times when it might be necessary for you to receive general anesthesia for your Cesarean birth. General anesthesia’s where you’re given medicines through your IV, and these medicines will make you go off to sleep for the surgery. Anesthesia medicines will be continued that will keep you asleep until the surgery’s completely done.

Regardless of the kind of anesthesia that you have for your Cesarean birth, you will receive pain medication to help you to feel as comfortable as possible after the surgery.

We at Allina Health are fully committed to seeing you through the birth process as comfortably and safely as possible.

Most pregnancies last between 37 and 42 weeks, but it is normal for babies to be born from 3 weeks before to 10 days after a due date.

The first stage of labor often begins with what are called contractions – when the cervix begins to open and thin, and the muscles of the uterus begin to tighten.

During contractions, you may also have an upset stomach, cramps, an aching back, or some pain in your abdomen or thighs. Although this is uncomfortable, it is also very normal.

Labor can last many hours, but your health care team will be with you through each stage of labor, explaining what it happening, and helping to make you as comfortable as possible.

As you learned in chapter two, there are anesthetic and prescription pain relief options that you and your anesthesiologist will discuss. However, as you learned in chapter one, there are other relaxation techniques that you can also practice that don’t involve any medicines.

During labor, it is natural to tense your muscles, increase your rate of breathing – which increases your heart rate – and try to fight whatever pain you are feeling. But in childbirth, it is important to relax your mind and body during labor, which lowers your blood pressure and increases oxygen in your bloodstream, bringing more oxygen to your uterus and baby. Relaxation helps provide comfort.

Some ways to relax may include watching TV, reading a book, listening to music, or talking with family or friends.

In chapter one, you learned about two of the best ways to relax: breathing and guided imagery.

Focusing on your breathing helps lower anxiety. Breathing slowly at first is the best way to relax. You can breathe slowly both during and in between contractions, but keep your breathing even and easy. Soft music may also help you relax.

If you have been practicing the guided imagery techniques you learned about in chapter one, now would be a good time to use these techniques. Allina Health hospitals provide MP3 audio players for guided imagery, or you may bring your own audio player from home. You can also guide yourself to your favorite place simply by closing your eyes and concentrating on the sounds, colors, scents, and textures of the place you are imagining. Again, soft music usually helps. Stay in your favorite place for a few minutes, enjoying peace and comfort.

Moving your body is also a very good way to ease discomfort during labor. Lying in the same position for too long can be painful, and it can slow labor. Change positions often. If your health care team says it is okay, take a walk in the hallway, having a family member or friend help you, if necessary.

If you have been practicing the different body-positioning techniques mentioned in chapter one, have a partner or family member help you with these exercises. Anything you can do to move your body will be helpful during labor.

Something cold can also dull pain, and heat can help you relax. For cold therapy, try applying an ice pack to an area that is causing you discomfort. For warmth, a heat pack, or a warmed blanket can be helpful. Wrap cold and hot items in a towel to protect your skin.

Asking a partner, family member, or friend to give you a foot, hand, or shoulder massage can help relieve emotional tension, anxiety, and pain during labor. Even a light touch – like the stroking of your hair or your forehead – can be very soothing.

As contractions get stronger, you may feel some pain in your lower back. The heel of a hand or even a tennis ball in this area can be comforting.

As you learned in chapter one, breathing the essential oils in aromatherapy can also help reduce anxiety, ease your pain, and help you feel better during labor.

Ask your health care team if it is okay to bathe. The feeling of warm water from a bath or shower may help you relax during labor. It is important to keep the water temperature around body temperature – 98 to 100 degrees Fahrenheit. – to prevent fever in you and the baby.

Remember to give yourself positive and encouraging messages, which are called labor affirmations. Say them out loud or to yourself, but say things that are important to you, such as ‘My body knows what to do’, or ‘I am doing fine, and my baby is doing fine.’ Whatever positive things you wish to say will be very helpful in relieving anxiety as you get ready to give birth.

Labor can be a challenging experience, but you have learned many ways to help you relax and ease any discomfort. If at all possible, try to sleep between contractions. This will help conserve your energy for the second stage of labor, when your baby is born.

Always remember, giving birth is a natural experience, and your body is strong enough to handle it. Your health care team will be with you every step of the way to help you cope with any discomfort as you give birth to your baby.

After your delivery, you may feel some discomfort in certain areas of your body. This is very common.

Within a few hours after birth, you may feel some stinging the first few times you use the bathroom.

If you had an episiotomy or tear, there may be some swelling and soreness around your vaginal area.

For a few days, you may also feel your uterus contract, which is sometimes called afterbirth pains, and are often most strong when you breastfeed.

Whatever discomforts you may feel, your nurse will describe to you what is called a care map – a guide to help manage your pain, take care of yourself, and get to know your baby during your hospital stay.

You are the only person who can describe your pain, but your health care team will work with you on ways to rate your pain – so that your providers know how best to help you feel better. The important thing is to be consistent in how you rate your pain, so that your health care team will know how best to treat you.

Your health care team will tell you about different types of medicine that may be right for you. But there are many other ways you can control some of the discomforts you are feeling. Mothers who take an active role in their own healing often recover more quickly.

If you had an episiotomy or tear, ice packs on your vaginal area may help to ease the pain.

If it stings when you urinate, it is sometimes helpful to use the bottle provided to squirt warm water onto your vaginal area, which reduces the discomfort.

If you have cramps in your stomach area, using a heat pack can help. Wrap the pack in a towel to protect your skin.

Walking is a great way to reduce the aches and pains you may be feeling.

Just like during labor, breathing the essential oils in aromatherapy can also help reduce anxiety, ease your pain, and make you feel better.

And taking a warm bath or shower can help soothe your muscles and make you feel refreshed.

Although there are many types of pain relief available to you, it is very important to tell your nurse if your pain relief is not working, or if you feel any new pain. Your health care team wants to help you feel better and recover as soon as possible.

One of the best ways to help ease your own discomfort is by rooming- in with your new baby – keeping your baby with you as much as possible while you recover at the hospital.

It is during this time that your health care team will help you with breastfeeding, as well as ways to help ease the discomfort that breastfeeding sometimes causes.

Rooming-in is safe for healthy babies and their mothers. Babies who room-in with mothers often: feed better, cry less, and lose less weight.

While you are awake, you can hold your baby while lying in bed or sitting in a chair. When you sleep, your partner can hold the baby, or the baby can sleep in a crib.

Mothers who room-in with their babies: sleep much better than mothers who do not room-in – and getting better rest helps them recover more quickly; feel less discomfort because their focus is on their babies; and develop greater confidence in their ability to care for their babies.

As you recover in the hospital, your health care providers want to be sure of several things, including:

  • You can walk around by yourself
  • You know how to take care of yourself and your baby
  • You are not bleeding too much, and if you have stitches, they have begun to heal
  • You do not have a fever, and you can manage your pain
  • Your baby has had at least two successful feedings, and has had both wet and soiled diapers

The time it takes for all of this to happen is different for each mother and baby. Your health care team will partner with you to follow your care map and meet all of these requirements. Once you do, you may return home with your baby.

The recovery time that follows the birth of your baby is called postpartum and means “after birth.”

Postpartum is a special time, as you get to know your baby. But it is also a time of adjustment; you may still feel some pain from giving birth.

As you recover at home with your baby, there are many ways for you to care for yourself as you continue to heal during this postpartum period.

You may feel what is sometimes called “afterbirth pain”, when your uterus contracts off and on. To ease any discomfort, you may gently massage your lower abdomen, lie face down with a pillow under your stomach, or use a heating pad. Relaxation breathing techniques – which you learned in chapter one – are also a good way to relax and create comfort.

If you had an episiotomy in the hospital, your stitches will dissolve without having to be removed. If your vaginal area feels tender, a warm bath usually helps. Also, use a squirt bottle to rinse the area with warm water when you use the bathroom. Rinse from front to back, and pat bathroom tissue in the same direction. Do not wipe.

You may have hemorrhoids, which will shrink in two to four weeks. Ice packs or cold gels – wrapped in a clean towel – usually help ease discomfort. Talk to your health care provider before using any over-the-counter creams. If your hemorrhoids are still painful at your postpartum checkup, your health care team can recommend other treatment options.

New mothers often feel some pain in their breasts during the postpartum period, including sore nipples. Keeping your breasts dry, changing your breast pads often, and applying non-petroleum and non-alcohol ointment to your nipples usually helps.

Your breasts may also become engorged – swelling with extra fluid. To help ease the discomfort of engorgement, feed your baby often – eight to twelve times every twenty-four hours. You may also want to gently massage your breasts before and during feedings. Try different nursing positions that make you comfortable. And let your baby drain the first breast before offering the second breast.

Your breasts may become engorged even if you are formula feeding. If so, hand express or pump milk for relief, which you can also do if you are breast feeding.

Breastfeeding should not hurt. You should call your Lactation Support Resources if you have pain in your breasts that won’t go away after your baby starts feeding; your nipples are cracked, blistered, red, or bleeding; you are unsure if your baby is feeding effectively, or if your breasts are not draining enough.

It is also common to be constipated after giving birth, especially if you are taking pain medicine. Make sure you follow the directions in your After Visit Summary about what to eat and drink. Talk to your health care provider before using any stool softener or laxative.

Caring for your baby around the clock is tiring. Because your baby will usually only sleep for two or three hours at a time, you may become exhausted. It is very important to try to sleep whenever your baby does. Ask your partner or a family member to care for your baby if you need to sleep.

If you do not feel sleepy, try a warm bath or some of the relaxation techniques you learned about in chapter one, such as breathing exercises or guided imagery.

More than half of all new mothers feel depressed after giving birth, usually within three or four days. There are a number of reasons for this, including lack of sleep, feeling overwhelmed, and hormonal changes in your body.

You may feel sad, anxious, or have trouble sleeping or eating. You may have low energy and feel like doing nothing – followed by periods of high energy where you are overly excited and want to do too much.

Although these feelings may be scary at times, just remember that postpartum depression is common, and that it eventually goes away. It is important to get enough rest if you are too anxious, and to try to move your body if you feel tired much of the time.

Talking about your feelings with your partner, family member, or a close friend is very helpful during this time.

It is also very helpful to use some of the alternative therapies you learned about in chapter one. Aromatherapy, guided imagery, massage, and other mind-body skills are excellent ways to help you feel grounded, so you can continue to care for your baby and yourself.

If your feelings of depression seem to be too overwhelming and will not go away, call your health care provider. Help is always available.

During your postpartum recovery at home, it is very important to keep all your follow-up appointments with your health care team – who can address any questions or concerns you may have about how to care for yourself and your baby as you recover at home.

Your health care provider is always available and prepared to help you deal with what may seem like a difficult time in your life – but which can also be a time of great joy. Just remember that you and your baby are not alone. Allina Health will be there for both of you.

If you need to start pushing before you have an urge to, try squatting, kneeling or sitting on the toilet. As the second stage of labor progresses, your urge to push will likely get stronger.

Many women feel the urge to push as a need to bear down or to a have a bowel movement. When you push, direct your energy toward your perineum, the area around your vagina. If you need some help directing your pushing, ask.

Your nurse or health care provider can hold a warm washcloth on your perineum. Or, that person can put two fingers in your vagina and press toward your rectum.

Some women don't feel a strong urge to push. Pain medicines may sometimes reduce the urge. Your nurse or health care provider can tell you when to start pushing and help you.

How to push

  • As the contraction builds into an urge to push, take relaxing breaths.
  • When you have the urge to push, take a full breath and let it out. Then take a breath and push into the pressure. It's OK to make sounds during the push.
  • Continue taking new breaths every five to six seconds until you no longer feel an urge to push or you are told to stop pushing. Do not hold your breath for more than a few seconds at a time.
  • When the urge to push is gone, take a full relaxing breath and return to a resting position until the next contraction.

Positions to try

Your health care team will suggest positions and ways to adjust the bed that can make your pushing most effective.

standing150x202
Upright positions use gravity to help your baby move through your pelvis.
squatting150x202
Squatting or sitting helps widen the pelvic outlet.
sitting150x202
Pushing on hands and knees can help your baby turn to a better position.
side lying150x202
Lying on your side may help your baby turn and reduce pressure if your baby is coming too quickly.

Tips for pushing

Relax your perineum and pelvic floor. This makes pushing more effective. It also reduces the chance of tearing and the need for an episiotomy. An episiotomy is an incision (cut) made to enlarge the vaginal opening just before your baby is born. Warm washcloths on the perineum may increase your comfort. Relax your jaw and mouth—this helps relax your pelvic floor.

Direct your pushing downward. Don't strain. Straining makes your face red, your eyes bloodshot, and your neck muscles taut. These are signs that some of your pushing force is going up rather than down. Straining is also exhausting. Instead, focus on using your abdominal muscles to push down, out and away. This is what you do when you are trying to urinate faster.

Make some noise. Pushing is hard, physical work. You don't have to do it quietly. Grunt, moan, make I'm-working-hard-to-get-this-baby-born noises. High-pitched noises and screaming do not help your pushing effort. They show your energy is moving up, toward your face. Instead, make low, deep sounds that help "aim" your pushing downward.

Use your labor companion. Take encouragement from your labor companion's words of support. Let him or her know what words and actions encourage you. In addition, this person can help physically support you. The positions for labor and birth charts show how your partner can help.

Touch your baby's head. As your baby's head begins to appear at the vaginal outlet, you can reach down and touch your baby's head. This may help direct your pushing. You can tell that your baby will soon be born.

Birthing your baby's head

When your baby's head reaches the vaginal outlet and is about to be born, you may feel burning or stinging. Your health care provider may ask you to stop pushing to allow your perineum to stretch gradually.

If you are told not to push, put your head back and breathe lightly and quickly. This does not take away the urge to push. However, it does stop you from pushing forcefully. That allows your baby's head to be born more slowly, reducing the chance of a tear.

Reducing tears or episiotomies

There are things you can do to reduce the chances of a tear or the need for an episiotomy. An episiotomy is a small cut in your perineum to allow more room for the baby's head.

  • Relax your pelvic floor and perineum every time you push.
  • Use perineal massage. Gentle perineal massage by your nurse or health care provider can help stretch your perineum.
  • Use positioning. When you push while squatting, kneeling or sitting on the toilet, your baby's head presses evenly all around the opening of your vagina.
    • Squatting can strain your knees and hips if you are not supported. Use the bed, a squatting bar or your labor companion to help support your weight.
    • Squat only during contractions. Between contractions stand, sit or rest on your hands and knees.
  • Let your uterus birth your baby's head. Stop pushing as your baby's head is born. Follow your health care provider's directions.

Source: Allina Health's Patient Education Department, Beginnings: Pregnancy, Birth and Beyond, seventh edition, ob-ah-90026
First Published: 10/04/2002
Last Reviewed: 12/02/2015

Tips to help you choose a pregnancy care provider - teaser
Tip

Your ability to relax is as important as your ability to push. Your uterus can push your baby out. Don't strain.

Focus on relaxing your lower body so your baby can be born.