If you haven't heard yet, there is some new research recently published in the American Journal of Obstetrics and Gynecology that is bringing renewed attention to the pushing stage of labor. Specifically, when pushing actually needs to begin.
In most hospital settings in the United States, it’s standard practice to encourage active pushing as soon as someone is found to be fully dilated at 10 cm. For many birthing people, this means pushing with every contraction whether or not they feel an urge to do so.
This study looked at a over 10,000 births that occurred in a hospital in France - where the standard practice is to allow babies to "labor down". ("Labor down" refers to allowing the uterus to do the work of moving the baby down into the pelvis, rather than exerting maternal effort via the pelvic floor muscles as soon as full dilation is reached).
The results were pretty remarkable. (Though not surprising to midwives and doulas who've carried down this wisdom for centuries.)
According to this study, when pushing was delayed until the urge was present and the baby had descended naturally, the amount of time spent actively pushing was significantly shorter...like minutes instead of hours. Considering that many first-time parents are told to expect one to two hours of pushing (or more), this research is a game changer.
According to the study, the average pushing time was around 8 minutes, with most people pushing for less than 15 minutes total. Rates of postpartum hemorrhage and severe tearing were low, and newborn outcomes were reassuring. In other words, waiting didn’t make birth harder or more dangerous. It actually made pushing more efficient and gentler on the body, with positive outcomes for both mom and baby.
From a physiological perspective, this isn’t surprising. The uterus is incredibly capable of moving the baby down on its own. When we allow that descent to happen and wait for the reflexive urge to push, the body often does much of the work without force or strain.
This is ancient wisdom that modern research is finally catching up to.
While we, as birth workers, are sooooo excited to finally have this research in black and white, it's important to note that new research doesn't necessarily lead to a change in practice - at least not right away. In fact, it takes an average of 15-20 years for new evidence to be implemented into standard practice in the hospital.
So if you’re planning a hospital birth, this is something worth bringing into the conversation. Reading the research, printing it out, and sharing it with your care team can help you advocate for waiting to push until your body and baby are ready.
Sometimes the most supportive thing we can do in birth is simply allow the body to do what it already knows how to do. And we're so glad that, little by little, science is catching up.
If You’re Preparing for Birth in Lincoln, NE
If you’re in the Lincoln, Nebraska area and preparing for birth, I offer doula support that centers physiology, evidence, and trusting the body’s innate wisdom. You’re welcome to schedule a free consultation to talk through your options, your preferences, and the kind of support that feels right for you.