Pushing during labor is one of the most critical parts of giving birth. After going through hours of contractions, you finally get to the pushing stage, which moves the baby down the birth canal. While the urge to push may seem overpowering, your doctor may advise you not to push at certain times. There are important reasons why controlling your pushing is essential for a safe delivery.
When would a doctor recommend not pushing?
Doctors typically recommend not pushing in the following situations:
- During the early first stage of labor – Pushing too soon can cause the cervix to swell, which delays dilation.
- Before the cervix is fully dilated to 10cm – Pushing before full dilation can cause the cervix to tear or the baby to get stuck.
- When the baby’s head delivers but their body doesn’t follow – Allowing the head to naturally turn can prevent injury.
- During a contraction that follows head delivery – This allows the shoulders to deliver one at a time.
- When the doctor performs an episiotomy – Controlled, gradual pushing helps prevent extensive tearing.
- If the umbilical cord is wrapped around the baby’s neck – Gentle pushing gives the doctor time to unwrap the cord.
- When waiting for forceps or vacuum extraction – Steady, non-forceful pushing prevents fetal distress.
Let’s look at the reasons behind these recommendations in more detail:
Pushing too soon
Pushing before you are completely dilated stresses the cervix. The uneven pressure can cause swelling or edema. This swelling blocks the opening, preventing the cervix from dilating further. Trying to force the baby through an undilated cervix also increases the risk of hemorrhage.
Doctors typically instruct women to pant, blow, or use shallow breaths during contractions until the cervix is fully open. This prevents unproductive pushing against a closed cervix.
Pushing before full dilation
When you start pushing too early, before the cervix reaches complete 10cm dilation, complications can occur:
- Cervical lip – The cervix may swell at the edges, leaving a cervical lip that blocks the baby from descending.
- Cervical laceration – Forced pushing can cause the cervix to tear.
- Prolapsed cord – The umbilical cord can get compressed and slip into the vagina ahead of the baby.
- Baby stuck – The baby’s head may crown but their body can’t pass through an incompletely opened cervix.
Doctors will check for full dilation before allowing active pushing. If a cervical lip remains, they may recommend techniques like holding a warm compress on the cervix to aid complete opening.
When the baby’s head delivers
It’s tempting to give one big push when the baby’s head emerges. However, doctors will ask you to stop pushing at this point. This pause allows the baby’s head to turn naturally, letting the shoulders align to deliver one at a time.
Stopping also enables the doctor to suction fluids from the baby’s mouth and nose. Vaginal stretching prepares for the shoulders to pass through. Slow, controlled pushing prevents risk of injury to both mother and baby.
After the baby’s head delivers
Doctors typically recommend not actively bearing down with the first contraction after the head emerges. This short pause before delivering the shoulders reduces the risk of complications such as:
- Oxygen deprivation – Intense pushing can temporarily reduce blood flow through the umbilical cord.
- Nerve damage – Excessive pressure can overstretch and injure the baby’s neck.
- Fractured collarbone – Aggressive pushing may break the fragile clavicle.
- Brachial plexus injury – The network of nerves around the neck and shoulders can get damaged.
Letting the baby descend gently and naturally protects both you and your baby.
During an episiotomy
An episiotomy enlarges the vaginal opening by making a surgical cut. This is done during delivery to allow smoother, safer passage if a tear seems likely. When an episiotomy is performed, the doctor will ask you not to push temporarily.
Panting or breathing slowly enables a slow, controlled birth rather than a forceful ejection. This reduces additional tearing and minimizes the episiotomy incision.
When the umbilical cord is wrapped
It’s not uncommon for the umbilical cord to loop around the baby’s neck or shoulder on the way out. If the doctor finds a cord wrapped tightly around the baby, they may ask you to temporarily stop pushing hard.
This pause enables them to quickly unwrap the cord and prevent compression that could cut off blood flow. Once the cord is free, you can resume active pushing.
Waiting for forceps or vacuum extraction
If problems occur during delivery, interventions like forceps or vacuum extraction may be needed. In these situations, you will be coached not to push vigorously.
Controlled pushing without forcing prevents marked fluctuations in the baby’s heart rate. It allows safe, gentle application of instruments to guide the baby out.
Can refusing to push harm the baby?
It’s understandable to want to push with all your might when that primal urge hits. However, giving in to overwhelming urges can sometimes damage your baby.
Potential risks from uncontrolled, forceful pushing include:
- Cord prolapse – Pressing before full dilation can trap the umbilical cord.
- Postpartum hemorrhage – Intense pushing may lead to uterine bleeding.
- Oxygen deprivation – Extreme pressure can temporarily reduce blood flow.
- Head and nerve injuries – Forcing can overstretch and harm the baby’s neck.
- Broken collarbone – Aggressively propelling the baby can break the fragile clavicle.
- Facial injuries – Battering the baby against an undilated cervix may bruise their face.
- Intracranial hemorrhage – A dramatic surge out can cause bleeding in their brain.
That’s why it’s so important to follow your provider’s guidance about when to push, pause, or gently breathe through urges. Controlled pushing promotes a safer delivery.
Can refusing to push prolong labor?
While brief pauses in pushing do not significantly prolong labor, consistently refusing to push can stall the process. Potential risks include:
- Exhaustion – Resisting urges to push takes tremendous effort and stamina.
- Fetal distress – Delayed delivery deprives the baby of oxygen.
- Infection – A prolonged labor increases risk of maternal or fetal infection.
- Hemorrhage – Continued contractions may cause uterine bleeding.
- Emergency C-section – Failure to progress will eventually require a surgical delivery.
Once pushing is appropriate, your provider will coach you when a temporary stop is needed for safety. But they will also encourage you to bear down when the time is right to keep labor moving.
When should you avoid pushing during labor?
As a general rule, you should avoid pushing your hardest during these stages of labor:
- Early in the first stage before 5-7cm dilation
- When the cervix is not yet fully open
- Between the birth of the head and the body
- Right after the head delivers
- During an episiotomy
- When the cord is wrapped around the baby
- While waiting for forceps or vacuum-assisted delivery
Other than these critical periods, you will be coached to bear down with each contraction during the second stage. This descent through the birth canal speeds up delivery.
What should you do instead of pushing?
When your provider advises you not to push, you can:
- Pant or blow – Short breaths prevent you from actively bearing down.
- Do mini-pushes – Gentle pushes allow gradual descent without forcing.
- Rest between contractions – Conserve energy for when active pushing begins.
- Stay calm – Tension hinders progress. Relaxation helps dilation.
- Change positions – Experiment to find what feels most productive.
- Focus elsewhere – Distract yourself from urges to push improperly.
- Listen to cues – Follow your team’s guidance throughout each stage.
Controlled breathing techniques help you work with your body rather than causing harm by pushing recklessly.
Here are some key takeaways about why avoiding pushing is recommended at certain points during labor:
- Pushing too soon can impede progress by causing cervical swelling.
- Pushing before complete dilation raises the risk of complications.
- Pausing after the baby’s head delivers allows controlled delivery of the shoulders.
- Slow pushing protects both you and your baby from injury.
- Forcing when interventions occur prevents further harm.
- Following instructions for when not to push promotes a safer birth.
While it can be challenging to resist the urge to push, this control is necessary for key stages. Listen to your providers and allow your body to gradually deliver your baby safely.
Pushing is a critical part of labor that takes guidance and finesse. Although the urges feel overwhelming, forcing when the cervix is not ready can cause problems like swelling or fetal distress. Brief pauses at key moments, like after the head delivers, enable a gentle, protective delivery. While you may want to end the marathon of labor with an all-out sprint, controlled pushing based on your doctor’s prompts truly helps ensure a smooth finish.