“Don’t Push Yet!”
As a doula, I have heard these words many times during labor:
"Don't push yet—we need to make sure you're fully dilated."
Picture the scene: labor has progressed beautifully, and the birthing mother begins to grunt with contractions. She says, "I feel like I have to push!" In many hospital settings, a nurse's first response may be to tell the patient not to push until someone can check cervical dilation. In a home birth setting with a midwife, you may hear something more like, "That's a great sign—you'll be meeting your baby soon."
Why can these responses sound so different?
One reason is that different birth settings often approach the second stage of labor differently. In many hospitals, there are established protocols for assessing dilation and guiding pushing efforts. Care providers may want to confirm that the cervix is fully dilated before encouraging strong, directed pushing. This recommendation is intended to protect both mother and baby and to reduce the risk of swelling or injury to the cervix, but it can lead to unnecessary discomfort for the birthing mother.
Many birth teams teach what is called "directed pushing" or "purple pushing." During directed pushing, mothers may be coached to take a deep breath, hold it, and push forcefully for a count of 10 seconds, and repeat this at least three times, during each contraction. Directed pushing without medical necessity can sometimes lead to lower oxygen levels for the baby and increased risk of tearing for the birthing mother. It can also wreak havoc on your pelvic floor.
In a home birth, and in some hospital settings, mothers are encouraged to follow their body's natural urges with physiologic or instinctive pushing. They may change positions freely, vocalize, breathe as needed, and push according to what feels most effective. Many women find this approach more intuitive and less exhausting.
When a mother feels the urge to push before full dilation, care providers may have different opinions about how to proceed. Some prefer waiting for complete dilation before encouraging strong pushing efforts. Others recognize that gentle, involuntary bearing-down efforts can be difficult (and sometimes impossible) to suppress. These efforts can actually bring about complete dilation, and these providers don’t attempt to stop you.
If you find yourself feeling the urge to push during labor, communicate openly with your care providers. Ask questions. Understand their recommendations. But most importantly, stay connected to your body and your instincts. Remember that, as the patient, you have the right to make informed decisions about your care.
Birth is not something your body has to be taught. Your body and your baby are working together in a remarkable process that has been designed by your Creator with wisdom and purpose.
For more information about directed pushing versus instinctive pushing, see this “Today’s Parent” article. https://www.todaysparent.com/pregnancy/giving-birth/are-women-pushing-too-hard-and-too-soon-during-labour/
Disclaimer: Every labor and birth is unique. The information in this article is intended for educational purposes and should not be considered medical advice. Always discuss questions or concerns about your labor and birth with your healthcare provider. Care recommendations may vary based on the specific needs of the mother and baby.
Joy Elliott