How to push during labor: breathing, positioning, and pelvic floor guidance

As your due date gets closer, it’s completely normal to feel a mix of excitement and nerves. While you can’t wait to meet your baby, you may also find yourself wondering what the pushing stage of labor will actually feel like. Will you know when to push? What if you push the wrong way? Will you tear? What if you get exhausted?

If you’re feeling uncertain, remember this: Your body is designed for this. While there isn’t one “perfect” way to push, learning a few breathing and positioning strategies ahead of time can help you feel more prepared. “The best preparation is understanding and listening to your body, and practice can help,” says Lori Walter, PT, DPT, a Hinge Health physical therapist.

Ahead, learn what happens during the pushing stage of labor, different breathing and pushing techniques, and how pelvic floor physical therapy, including exercises recommended by Hinge Health physical therapists, can help prepare your body for delivery.

What happens when you push during labor

Pushing begins once your cervix is fully dilated to 10 centimeters. This is also known as the second stage of labor, which can last anywhere from about 20 minutes to several hours, depending on factors such as whether it’s your first vaginal delivery, your baby’s position, and how labor is progressing.

While it may feel like all the work falls on you, your body will guide you through most of the work.

“Your uterus is actually the strongest muscle involved in labor,” says Dr. Walter. “Those contractions are what move your baby down through the birth canal.”

At the same time, your deep abdominal muscles help create pressure that supports those contractions, while your pelvic floor muscles gradually lengthen and relax to allow your baby to pass through the vaginal canal. The pelvic floor can stretch to nearly three times its resting length during delivery.

When it’s time to push, you work with your contractions by increasing pressure through your abdomen to help guide your baby lower. “It’s really about coordinating your breathing, abdominal muscles, and pelvic floor,” says Dr. Walter, “rather than simply pushing as hard as you can.”

Breathing strategies for pushing during labor

There are two main breathing approaches used during the pushing stage of labor.

• Closed-glottis pushing. Sometimes called the Valsalva maneuver, this technique involves taking a deep breath, holding it, and bearing down for about five seconds. Many people repeat this two or three times during each contraction.

• Open-glottis pushing. With this approach, you take a deep breath and slowly exhale while pushing, as if you're blowing through a straw, for about five seconds, repeating as needed during each contraction.

Research suggests both approaches can be effective. “You don't have to use the same strategy for your entire labor,” says Dr. Walter. “If one approach starts to feel exhausting or isn’t working well, it’s okay to switch. Your labor team can help guide you.”

Best positions for pushing during labor

Many people picture giving birth lying on their backs, but that’s only one of several options. Depending on your comfort, your baby’s position, and any medical considerations, you may feel more comfortable pushing while standing, squatting, on your hands and knees, lying on your side, or in another position.

Changing birthing positions throughout your labor can also help you stay more comfortable and may help the process progress. Upright positions, such as standing or squatting, may offer several benefits for some people, including:

• Speed up labor

• Help dilate the cervix and widen the pelvic opening

• Encourage the baby’s descent through the birth canal (thanks, gravity)

• Help ease pain

• Reduce the risk of perineal tearing during delivery

That doesn’t mean upright positions are always the best choice. If you have an epidural (which numbs your body below the waist), you won’t be able to stand or use upright positions that require you to support your own weight. Instead, you’ll be limited to supported positions in bed — like lying on your side or semi-reclining on your back — and your care team will help you adjust as needed.

“There isn’t one perfect birth position,” says Dr. Walter. “The best position is the one that’s safe for you and your baby, while also helping you feel supported and able to push effectively.”

How to push during labor without tearing

It’s understandable to worry about tearing during childbirth. But up to 90% of vaginal deliveries involve some degree of perineal tearing. Most tears are minor and heal well within a few weeks.

While there’s no guaranteed way to prevent tearing, several strategies may help your tissues stretch more gradually and reduce the risk of more severe tears.

• Try a perineal massage. Starting around 34 weeks of pregnancy, gentle perineal massage may improve tissue flexibility and help you become more comfortable with the sensation of stretching during birth. “It can also reduce some of the fear and uncertainty around pushing, creating more awareness and comfort with your pelvic floor,” says Dr. Walter.

• Push with control. Rather than pushing as hard and fast as possible, working with your contractions and using steady, controlled pushes gives the perineal tissues more time to stretch. Your healthcare provider or midwife may also support your perineum with gentle counterpressure during delivery.

• Experiment with different birth positions. Side-lying, squatting, and other birth positions may reduce strain on the perineum (the tissue between the vagina and anus).

• Use warm compresses. Applying a warm compress to the perineum during the pushing stage may increase blood flow, encourage tissue relaxation, and reduce the likelihood of more severe tears.

• Prepare your pelvic floor ahead of time. Learning how to relax your pelvic floor, not just strengthen it, is one of the most valuable ways to prepare for labor. A pelvic floor physical therapist (PT) can teach breathing, relaxation, and pushing strategies that help your muscles lengthen more easily during delivery.

How physical therapy helps with labor and pushing

Pelvic floor physical therapy during pregnancy isn't just about strengthening your muscles; it’s also about learning how to relax, coordinate, and trust them when labor begins. “Many people think the pelvic floor should always be tight and strong,” says Dr. Walter. "But during birth, those muscles need to lengthen and relax to allow the baby to pass." A pelvic floor physical therapist can help you prepare for labor by teaching you how to:

• Relax and lengthen your pelvic floor. Learning to release pelvic floor tension may help your muscles stretch more easily during delivery and may reduce the risk of excessive strain or tearing.

• Coordinate your breathing. Diaphragmatic breathing helps your diaphragm and pelvic floor work together. During an inhale, your pelvic floor naturally lengthens. Practicing this pattern during pregnancy can make it easier to tap into that relaxation when you're in labor.

• Learn pushing techniques that reduce excessive strain. Open-glottis pushing, for example, may be gentler on your pelvic floor than closed-glottis. And avoiding prolonged breath-holding while pushing may help reduce downward pressure and pelvic floor tension for some people.

• Practice pushing techniques. A pelvic floor PT can help you practice different breathing and pushing strategies before labor begins, so they feel more familiar when it's time to use them. They can also teach you how to avoid unnecessary tension or prolonged breath-holding if it isn’t serving you.

You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit. Always check with your healthcare provider before starting any new exercise routine during pregnancy.

Tips for pushing during labor

There’s no single “right” way to push during labor. Your body, your baby, and your healthcare team will all guide the process. But a few simple strategies can help you feel more comfortable and confident along the way.

• Relax your jaw. “We often see tension travel through the body,” says Dr. Walter. “When your jaw softens, it’s often easier to let your pelvic floor relax, too.”

• Work with your contractions. Rather than pushing constantly, push during contractions, then use the time between them to fully rest and recover your energy.

• Breathe instead of bracing. Whether you use open- or closed-glottis pushing, try not to create tension throughout your body. Focus on steady breathing that helps you stay connected to your pelvic floor.

• Make low, open sounds. Some people find that low-pitched sounds or vocalizations help them avoid tightening their throat and pelvic floor during pushing.

• Use visualization. “One cue I like is imagining you're blowing up a balloon between your sit bones,” says Dr. Walter. “It encourages the pelvic floor to open instead of tighten.”

• Change birthing positions if needed. If one position feels uncomfortable or labor isn’t progressing, changing positions may help you feel more comfortable or make pushing more effective.

• Lean on your birth team. Your obstetrician, midwife, nurses, doula, and physical therapist are all there to coach you. Let them know what you’re feeling, ask questions, and don’t hesitate to ask for support if something doesn’t feel right.

PT tip: Practice relaxing your pelvic floor

A strong pelvic floor matters during pregnancy, but so does learning to let go of muscle tension. “We spend a lot of time talking about strengthening the pelvic floor, and that’s important,” says Dr. Walter. “But during labor, those muscles may need to stretch to nearly three times their resting length.”

Practicing diaphragmatic breathing, pelvic floor relaxation, and visualization exercises throughout pregnancy can help you become more aware of when you're holding tension and how to release it. That awareness can make it easier to work with your body during labor.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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