# Pushing — Second Stage of Labor

Source: https://www.pregnancypowerhour.com/birth/pushing-second-stage
Last updated: 2026-07-15

> The 'pushing phase,' or second stage of labor, is the active period from full cervical dilation until your baby is born, guided by your body's innate wisdom.

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](/birth/episiotomy) is no longer routinely recommended and is reserved for selective use only, a shift supported by ACOG.

## When it's recommended

The second stage of labor is a natural physiological process that every birthing person experiences. The 'recommendations' here are less about when it's needed and more about how to best support your body through it. Approaches like spontaneous pushing, upright positions, and perineal support are recommended as standard practice to promote a more physiological birth experience. Your care provider will monitor your and your baby's well-being throughout this stage, often using methods like [Continuous Electronic Fetal Monitoring (EFM)](/birth/continuous-fetal-monitoring) or intermittent auscultation to ensure your baby is tolerating labor well. If there are concerns about your or your baby's progress, or if complications arise, your provider may suggest specific interventions or adjustments to your pushing strategy.

## Brittany's doula perspective

As a doula, I often see how the second stage can feel both exhilarating and overwhelming. My role is to help you feel calm, clear, and confident in your choices during this powerful time. While routine practice in some settings still leans towards directed pushing or supine positions, the evidence strongly supports allowing your body to lead. You get to decide how you push and in what positions. We can explore various options that feel right for you, focusing on what promotes comfort and progress. 

This is a prime example of where informed consent truly shines. Understanding the evidence allows you to have a collaborative conversation with your care team about your preferences. Remember, your body is designed for this, and trusting its signals is key. Having [Doula Support](/birth/doula-support) during this phase can provide continuous encouragement, suggest different positions, and help you advocate for your preferences, ensuring your voice is heard and your autonomy is respected. Your provider is your best resource for your specific situation.