You're almost at the finish line (or more accurately, baby is) — but getting there is going to take a bit of pushing.
Up until this point, you haven't been able to do much to speed along the process of childbirth, but things are about to change. With cervical dilation complete, it's time to help your baby through the birth canal by pushing.
How long does it take to push baby out?
The second stage of labor (time from full dilation to delivery) generally takes 30 minutes to an hour if you don't have an epidural, and one to two hours if you do get an epidural. But it could take as long as three hours or more, especially with first babies.
You can thank your first baby for paving the way for a (usually) easier and quicker second stage for your second baby (and subsequent children).
What will you feel when it's time to push during labor?
During the pushing stage, your contractions should be more regular than the contractions in transitional (advanced) labor. They're still about 60 to 90 seconds each but are further apart (usually two to five minutes) and possibly less intense.
"The pushing phase for me was a relief!," says What To Expect Community mom ktowers728. "It took the most stamina to get through though, kinda like a hard workout."
You should now notice a well-defined rest period between contractions, though you may still have trouble recognizing the onset of each contraction.
Common in the second stage, though you'll definitely feel a lot less — or nothing at all — if you've had an epidural:
- Pain with the contractions, though possibly not as much as earlier
- An overwhelming urge to push (though not every woman feels it, especially if she's had an epidural)
- Tremendous rectal pressure (ditto)
- A burst of renewed energy (a second wind) or fatigue
- Very visible contractions, with your uterus rising noticeably with each one
- An increase in bloody show
- A tingling, stretching, burning, or stinging sensation at the vagina as your baby's head emerges
- A slippery wet feeling as your baby is born
How to push during labor
You may feel relieved that you can start pushing (though it's totally normal to feel embarrassed, inhibited, scared, or even frustrated, especially if it's taking longer than you anticipated). But it's time to get this baby out — so what do you do?
To get going, you'll move into the pushing position of your choice and, following the instructions of your practitioner or the hospital or birthing center staff, you'll push at regular intervals, usually three times with each contraction, or as you feel the urge.
Pushing is a two-steps-forward, one-step-back process. You'll sometimes feel (or if you use a mirror, see) your baby rocking forward and back. It helps to think of the first push as getting baby back to the place she ended last, the second push as keeping her there, and then the last push as making forward progress.
If you can, try to pace yourself so that you don't use all your energy with the first push and then not have anything left in the tank.
Sometimes you may want to rest for one contraction, especially if you're getting tired and not pushing effectively. Your health care team may even suggest that you rest to allow baby time to recover from the possible stress of pushing.
Otherwise, pushing strong and effectively with each contraction will allow you to build on progress and deliver your baby faster.
"I think the best thing I can do to improve this next birth is embrace pushing and not feel like it's just something that's happening to me as a pretty unwilling participant," says What To Expect Community mom liverandeggs.
Here are some more pushing tips to try:
- Push as if you're having a bowel movement. Relax your body and thighs and push as if you're having the biggest BM of your life. And speaking of bowel movements, put all your concentration and focus into the pushing, not into worrying about whether you'll be emptying your bowels or passing urine while you're at it. That happens to many moms during labor — and people who deliver babies for a living understand this, expect it, and don't think twice.
- Tuck your chin to your chest. If you're propped up on your back, make sure you put your chin to your chest to push. This position will help you focus your pushes downward, and it will help prevent you from arching your back, which could put the baby in a less-than-optimal position for descent.
- Give it your best effort. The more efficiently you push and the more energy you pack into pushing, the more quickly your baby will make the trip through the birth canal.
- Stay focused. Maintain control and try to avoid frantic pushing too — you don't want to push with your upper body or strain your face. Strong, steady, and long pushes are the most effective during much of this stage. As your baby starts to crown, your provider may have you push in shorter bursts, but not until the very end. So just listen for their instructions!
- Change positions. Sometimes, if the pushing isn't moving your baby down the birth canal, it may be helpful to change positions.
- Trust your instinct. Take a few deep breaths while the contraction is building so you can gear up for pushing. As the contraction peaks, take a deep breath and then push with all your might — holding your breath or exhaling as you do, whatever feels right to you. If you'd like the nurses or your coach to guide you by counting to 10, that's fine — but there's no magic formula. Do what comes naturally. Follow the urges you feel to push, and you'll deliver your baby. (Actually, you'll deliver even if you don't follow your urges or if you don't have the urge at all. If you're concerned, ask your practitioner, nurse, or doula to help direct your efforts.)
"I honestly kinda felt like I didn't really have control over my pushing," says What To Expect Community mom HStep, who "just let my body do its thing and it worked great …" - Rest between contractions. Pushing is hard work, so you'll need to conserve your energy and rest up for the next round. Enjoy some ice chips, a cool cloth, a good playlist — whatever allows you to fully recover for a few minutes between each contraction and be ready to go back at it with everything you've got.
- Stop pushing as instructed. Your practitioner may suggest you stop pushing for a couple of contractions so you can regain some strength or keep your baby from being born too rapidly. If you're feeling the urge to push, pant or blow instead.
- Keep an eye on the mirror. Once there's something to look at, watching your baby's head appear (and reaching down and touching it) may give you the inspiration to push when it gets tough. Try not to get frustrated if your baby's head emerges and then disappears again once you're within shouting distance of the finish line though. That's just how the process works.
"The little things that helped were calm environment, limited talking, encouraging words from my partner, being able to be present and breathe," says What To Expect Community mom ceji.
What is your medical team doing while you're pushing?
While you're pushing, the nurses and/or practitioner will give you support and direction as they continue to monitor baby's heartbeat with a Doppler or fetal monitor.
They also may apply a warm cloth to your perineum or use some lubricant around the baby's head to minimize any perineal tearing.
Your health care team will prepare for delivery by spreading sterile drapes and arranging instruments, donning surgical garments and gloves, and possibly sponging your perineal area with antiseptic.
If necessary, they'll perform an episiotomy (only in very rare instances, fortunately) or use vacuum extraction or forceps (also very rare).
Once your baby's head is out:
- Your practitioner may suction mucus from baby's nose and mouth, then help guide baby's shoulders and torso out (you'll usually only have to give one more small push to help with that).
- Your baby will be handed to you or placed on your stomach while the umbilical cord is still attached. Now's a great time for skin-to-skin contact, so lift up your gown and bring your baby close. Studies have shown that babies who have that contact right after delivery sleep longer and are calmer hours later.
- The umbilical cord will be clamped and cut — either by your practitioner or coach. Sometimes delayed cord clamping (60 seconds) may be recommended.
- If you've arranged for baby's cord blood to be collected, that will be done now.
- You'll also have to prepare for one last push, to deliver the placenta. But don't worry — this push won't need to be nearly as strong as those needed to deliver your baby.
What happens after delivery?
Your baby's first checkup comes right away, when nurses and/or a pediatrician give a quick score on things like heart rate, breathing, and reflexes.
Some babies need assistance adjusting to their new surroundings, and the Apgar score — taken at one and five minutes — helps your health care team determine if your baby's slower to respond than is common.
Your baby will also receive a brisk rubdown to help stimulate her to cry, which will help expel the amniotic fluid that she's been breathing from her lungs. Next, both you and baby will receive an identifying band.
Sometime in the first hour after birth, your baby will be weighed, have ointment placed in her eyes (to prevent infection), and have a vitamin K injection to help prevent intracranial hemorrhage. She'll be warmly swaddled, and a hat will be placed on her little head to prevent heat loss.
(In some hospitals and birthing centers, some of these procedures may be omitted. In others, they'll be performed while you're enjoying skin-to-skin and bonding with your baby.)
Then, assuming all is well, you'll get your baby back and you may, if you wish, begin breastfeeding (but don't worry if you and/or your baby don't catch on immediately). Later, it's off to the nursery for your baby for a more complete pediatric exam with some routine protective procedures (including a heel stick and a hepatitis B shot), along with any elective procedures, such as circumcision.
Once your baby's temperature is stable, she'll get her first bath, which you may be able to help give. If you're rooming-in, your baby will be returned to you as soon as possible.
After all the anticipation, effort, and teamwork, the pushing stage leads to the moment you've been waiting for: finally meeting your baby.
From your first contraction to your first cuddle, track your labor symptoms and contractions, plus find real-time tips and encouragement in the What to Expect app.
Whether it takes minutes or hours, whether you feel in control of every push or simply let your body take the lead, your persistence pays off in the sweetest way. The first cry, the first skin-to-skin snuggle, the first look into your newborn's eyes — these are the rewards for all your hard work.
So take a breath, soak it in, and remind yourself: You did it. Baby is here!
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