Coached Pushing During Labor? Some Experts Advise Against It

Waiting to bear down—instead of being told to push—could mean less tearing, to the relief of pregnant women everywhere.

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No one knows your body better than you. Yet for years doctors told women when to push. This is the image of birth you see in the movies—the woman on her back with her feet in the stirrups while being told to count to 10, hold her breath and start pushing. But recent research shows this traditional way to deliver might not be best, and may worsen a risk of tearing down there (ouch!). There might be a better way: to let each woman decide for herself when to push.

Listen to your body

A new birth program, developed by a hospital in England and now being introduced across the UK, looks to reduce the number of women with severe tears by changing how they push. Instead of being told when and for how long, women are encouraged to wait until their body signals an urge to bear down—kind of like the feeling of having to poop. Also, women can breathe naturally while they push instead of holding their breath, and can labor and give birth in different positions.

The idea is to help your body work more effectively at getting the baby out with less force, and less tearing. "Laboring women can walk, use birthing balls, bars and other accessories, as well as try a variety of positions," Clara Ward, MD, a maternal-fetal medicine specialist with McGovern Medical School at UTHealth and Children's Memorial Hermann Hospital, tells Fit Pregnancy. "At the time of delivery, a 'hands-off' or 'minimal hands' approach, allowing the fetal head to descend slowly so that it stretches the tissues, can be employed."

But is this kind of delivery really better? "The optimal pushing technique is unclear, but there is less effort involved with allowing the woman to bear down when she feels the need," Maisa Feghali, MD, an OB/GYN at Magee-Womens Hospital of the University of Pittsburgh Medical Center (UPMC), tells Fit Pregnancy. "There is also no convincing evidence of an optimal maternal position for pushing, although upright positions, including kneeling and sitting, have several theoretical benefits like an increase in pelvic dimensions and good fetal alignment." The laying down position like you see in the movies should be avoided, she says, because of compression of large blood vessels. Even so, the evidence of the "best" way to deliver is still not clear.

If these techniques do result in less tearing, it will mean an easier recovery with fewer issues later on. "Even a small reduction in the severity of a tear can translate into markedly less discomfort postpartum," Ward says. "These practices are likely good for many women to avoid postpartum nuisances related to vaginal laxity [a feeling of looseness], and even more minor and common tears."

Do these techniques always work?

This all sounds great, and the American College of Gynecologists and Obstetricians, along with the American College of Nurse-Midwives, have recognized the value of similar practices. But waiting for an urge to push isn't always so simple. Women who've had epidurals, for example, can't move around as much, and often can't interpret their body's signals as well, Feghali says. "A woman may not be aware of these cues under an epidural and may thus push, or be guided to push, in a way that is more forceful and thus more traumatic to the perineum [the vaginal area]," Ward says.

That doesn't mean a preggo who's had drugs can't have an easier delivery. Ward says the contraction monitor can be used to help a woman tap into a change in sensation. "I find that helping the patient to relax and focus using mental imagery results in not only more labor progress, but also a more calm and pleasant birth experience," she says.

Of course, there are always going to be circumstances that warrant more medical intervention in order to keep mom and baby safe. So if this kind of mom-led birth is what you want, talk to your doctor ahead of time to make sure it's right for you. "These conversations help set expectations and make sure that the patient and the team caring for her are on the same page," Feghali says.