The 'pushing phase,' also known as the second stage of labor, marks the incredible transition from full cervical dilation to the moment your baby enters the world. This stage is often anticipated with a mix of excitement and curiosity about how your body will instinctively work to bring your baby earthside.
What it is
The second stage of labor begins when your cervix is fully dilated to 10 centimeters and ends with the birth of your baby. For many, this is when the urge to push becomes undeniable, a powerful sensation that signals your body's readiness. It's a period of intense work, but also one where you often feel a renewed sense of purpose and connection to the process. Your care team will be monitoring your progress, and you'll be encouraged to find positions that feel most effective and comfortable for you. The duration of this stage can vary significantly, typically lasting less than three hours for first-time births with an epidural, and less than two hours without one, according to ACOG 2014 guidelines.
What the evidence says
Research offers clear guidance on approaches that can support a smoother, more gentle second stage. Evidence suggests that spontaneous pushing, where you respond to your body's natural urges, is associated with shorter pushing times and potentially less pelvic floor trauma compared to directed pushing (often called Valsalva pushing). This means listening to your body's cues rather than being told exactly when and how long to push.
Furthermore, upright pushing positions, such as squatting, side-lying, hands-and-knees, or kneeling, are often more effective and may lead to less trauma than pushing while lying on your back (supine lithotomy position). These positions utilize gravity and open the pelvis more effectively. For those with an epidural, 'laboring down' – waiting for a spontaneous urge to push before actively beginning – can reduce fatigue and may lower the rates of interventions.
Comfort measures like warm compresses applied to the perineum during pushing have been shown to reduce the incidence of severe tearing. Similarly, regular perineal massage in late pregnancy can reduce tears for first-time parents. It's also important to note that Episiotomy is no longer routinely recommended and is reserved for selective use only, a shift supported by ACOG.
