• Sarina Beasley, PT, DPT

How Do I Push?

Labor is hard - REAL hard! I've been through it twice, in two different ways. One medicated on a Pitocin drip with an epidural and the other on Pitocin without an epidural. The hardest thing to get a hang of, beside dealing with the unrelenting contractions, was how to efficiently push, especially with the epidural.


My first delivery was spent pushing for two hours. Baby's head would descend, then migrate back up over and over. I even requested a mirror- Boy, did it make a difference! If you aren't too queasy, I recommend using it not only as a motivator, but having the ability to see if your strategy is correct. By baby #2, I had a better grasp and pushing was minimal. I did get a tear or two (I grow large babies), but no hemorrhoids and without pelvic floor dysfunction.


Doesn’t it make you wonder how so many women can take hours to birth a baby, yet others have their babies in their arms in a matter of minutes? A big component is strategy. The others, like discussing baby's positioning, I will go into at a later date.


“Imagine trying to squeeze a watermelon through a garden hose”


One recent study in the American Journal of Obstetrics & Gynecology revealed that many women actually contract their pelvic floor muscles (PFM) when they perform a Valsalva maneuver. The Valsalva is when we forcibly hold our breath and push like we are trying to pop our ears on a plane - No bueno for our pelvic floors when done for extended periods of time. Imagine trying to squeeze a watermelon through a garden hose. Not. Gonna. Happen.

Breathe Your Baby Out

We should actually be blowing our air out through our mouths like blowing out birthday candles - not holding our breath. Secondly, bearing down for our PFM to descend and lengthen, therefore, allowing more space for baby to come through. You can see the difference in the picture below.


Effects of prolonged bearing down include pelvic organ prolapse, where the organs of our pelvic floor can descend down into the vaginal canal, which may also lead to issues with constipation and incontinence moving forward. You may also develop or worsen hemorrhoids, which are very common in pregnancy. Pass the witch hazel and sitz bath please! Remember, fiber and water are your best friends through pregnancy and beyond.


With Pittsburgh Pelvic Health, you are supported throughout your maternal journey. This is a skill that we can help you learn, as well as educate you in other labor and delivery tips to have a healthy, more comfortable labor.