Feeling the Urge to Push: What to Expect During the Pushing Stage of Labor

"I'm 39 weeks pregnant and everyone keeps talking about 'the urge to push' during labor. How will I know when it's happening? What if I miss it?"

This concern reflects one of the most common anxieties expectant mothers experience as they approach childbirth. The pushing stage represents the culmination of your labor journey- the powerful, transformative phase when you'll work with your body to bring your baby into the world.

The urge to push typically occurs during the second stage of labor after your cervix has fully dilated to 10 centimeters. While this sensation can feel overwhelming, understanding what causes it and how to recognize it can help you approach this intense experience with greater confidence.

What Does the Urge to Push Really Feel Like?

"People tell me it feels like needing to have a bowel movement, but is that really what it's like?"

The urge to push during labor is often described as an overwhelming, involuntary pressure that makes your body bear down. While the bowel movement comparison is common, many women describe it as far more powerful and all-encompassing.

The physiological mechanism behind this sensation is called the Ferguson reflex—a feedback loop triggered when your baby's head presses against stretch receptors in your pelvic floor. This pressure sends signals to your brain, releasing oxytocin and creating that powerful, involuntary urge to push.

As your baby descends through the birth canal, most women describe the feeling in various ways:

"It was like my body completely took over. I couldn't have stopped pushing if I tried."

"For me, it felt like intense pressure—like everything inside me was being pushed downward with incredible force."

"I experienced waves of pressure that built with each contraction, creating an undeniable need to bear down."

The urge to push typically coincides with strong contractions during the second stage of labor, though some women feel a constant pressure between contractions as well. Each contraction presents an opportunity to work with your body's natural expulsive efforts to move your baby through the birth canal.

Recognizing the Signs of Transition and Readiness to Push

"How will I know I'm transitioning to the pushing stage? Are there other signs besides the urge?"

Transition (the intense final phase of active labor) often comes with distinct signs that indicate you're approaching the pushing stage:

• Increased intensity and frequency of regular contractions

• A sudden burst of energy or second wind

• Feeling shaky, nauseated, or hot and cold flashes

• Increased pressure in your rectum and perineum

• A change in the sound of your vocalizations during contractions

When your cervix reaches complete dilation (10cm), your healthcare provider will typically let you know you can start pushing with contractions. However, some women experience an early urge to push before being fully dilated. If this happens, your healthcare team may check your cervical dilation to determine if it's safe to push or if techniques to resist pushing are needed.

"What if I don't feel the urge to push even though I'm fully dilated?"

Not everyone experiences a strong, unmistakable urge, especially with epidural anesthesia or other pain relief methods. If you don't feel the urge to push despite being fully dilated, your healthcare provider might suggest:

1. Waiting for the passive descent of your baby (sometimes called "laboring down" or delayed pushing)

2. Using directed pushing techniques with contractions

3. Changing positions to increase pressure on your pelvic floor

Effective Pushing Techniques and Positions

Once you're actively pushing during labor, both your technique and position can significantly affect how effectively your body moves your baby down the birth canal. There are two main approaches to pushing:

Spontaneous Pushing: Following your body's natural cues, pushing when you feel the urge, usually in shorter bursts of 5-7 seconds while breathing between efforts.

Directed Pushing: Following specific instructions from your healthcare provider, often involving taking a deep breath at the beginning of a contraction, holding it, and pushing for counts of 10 (sometimes called "purple pushing").

"My doctor says I should hold my breath while pushing, but my doula suggests breathing techniques. Which is correct?"

Research suggests that spontaneous pushing may reduce maternal exhaustion and improve oxygen flow to your baby, while directed pushing might shorten the second stage slightly. The best pushing technique often depends on your specific circumstances, including whether you have an epidural.

Finding effective positions for pushing can make a significant difference in your experience. Different positions utilize gravity, pelvic dynamics, and body mechanics to help your baby's head navigate the birth canal.

"I have an epidural planned, will I still be able to push effectively if I can't feel the urge?"

 With an epidural, the sensation of the urge to push may be diminished or absent. Your healthcare team will likely guide your pushing efforts based on your contractions, and may recommend different positions even with limited mobility. Many hospitals now offer "walking epidurals" that maintain some sensation and movement while providing pain relief.

Managing Common Challenges During the Pushing Stage

"What if I feel the urge to push too early?"

Sometimes the urge to push arrives before your cervix is fully dilated. Pushing against an incompletely dilated cervix can cause swelling and complications. If you feel the urge to push early, try these breathing techniques:

1. Use the "breathe through" technique: focus on exhaling during contractions

2. Change positions to reduce pressure on your cervix

3. Use visualization to redirect your focus

4. Try small pelvic tilts instead of full pushes

"How long will I be pushing? I'm worried about getting exhausted."

The pushing stage typically lasts between 30 minutes to 2 hours for first-time moms and can be shorter for subsequent births. This wide range depends on several factors including baby's position, your pelvic structure, pushing technique effectiveness, and whether you have pain medication.

If pushing becomes prolonged (a long labor situation), your healthcare provider might suggest rest periods between contractions, position changes, or occasionally interventions like vacuum or forceps assistance to help guide your baby's head through the birth canal.

Supporting Your Pelvic Floor During the Pushing Stage

"I'm concerned about tearing or damaging my pelvic floor during pushing. How can I protect myself?"

The pushing stage does place significant pressure on your pelvic floor muscles as the vagina stretches, but several approaches may help minimize trauma:

Controlled pushing rather than forceful straining can allow tissues to stretch gradually. Some healthcare providers advocate for breathing techniques that avoid prolonged breath-holding, which can increase pressure on the pelvic floor.

Many midwives and doctors apply warm compresses to the perineum during crowning and may suggest perineal massage in the weeks before giving birth to increase elasticity of the tissues.

Your position during pushing matters too. Side-lying positions and hands-and-knees positions may reduce perineal pressure compared to semi-sitting positions.

"Will I know when to stop pushing when the baby's head is crowning?"

Your healthcare provider will typically guide you through this delicate phase, often suggesting shorter, gentler pushes or even panting to allow your baby's head to emerge slowly, giving tissues time to stretch.

The Moment of Birth

As your baby's head emerges, you'll likely feel an intense stretching sensation often described as "the ring of fire." This intense but typically brief sensation signals the final moments before meeting your baby. With guidance from your provider and perhaps a few more gentle pushes, your baby's shoulders and body will follow, completing the second stage of labor.

After giving birth, many providers encourage immediate skin to skin contact while waiting for the umbilical cord to stop pulsating before clamping, which can provide benefits for both the mother and baby.

Remember that the urge to push during normal labor represents your body's innate wisdom working to bring your baby into the world. By understanding this powerful physical response and learning to work with it effectively, you can approach this transformative experience with greater confidence and agency.

This article provides general information and should not replace medical advice. Always consult your healthcare provider about specific concerns during pregnancy and labor.