The Second Stage of Labor: The Pushing Stage

Ideas to Consider in the Pushing Stage of Birth

In this blog series, I have been talking a lot about big moments in birth that can change the course of a plan for physiologic birth. You can catch the full webinar here. The pushing stage of birth, also known as the second stage of labor (or even better – the fetal ejection reflex), is another moment that can challenge your birth plan. Wondering why? Let’s dive in.

Firstly, let’s talk about what it means when we say “the pushing stage.” In birth, we move from early labor, into active labor, through transition, take a natural pause, and then we move into pushing our baby out. This happens after the cervix is fully thinned and dilated to 10 cm.

Secondly, this stage could last anywhere from a few pushes to a few hours. In this stage, there are two types of pushing. You could call these philosophies or methods of handing the second stage of labor.

A Common Way to Handle the Pushing Stage…

The first strategy for handling the pushing stage is called coached pushing. This is when the birthing person is fully dilated to 10 cm and their provider tells them when, how, and where to push their baby out into the world. The most common application of this strategy is in hospital births where the doctor instructs the birthing person that it is time to push and counts how long to push with each contraction. This is very common with epidural anesthesia because the birthing person may not be able to feel their contractions to push effectively.

Many people move through pregnancy unaware of what their body is capable of. In our society, we basically have no idea what is normal or natural in physiologic birth (unless you have been lucky enough to be exposed to this information!).

Physiologic Pushing

The second strategy for handling the pushing stage is called physiologic pushing. This is an instinctual process. After reaching full dilation, the birthing person may experience a natural pause in their labor progression. This allows their baby to complete the final rotations and movements necessary to move into the best possible position for birth. Then, the birthing person will experience an intense and uncontrollable urge to push with contractions called the fetal ejection reflex. In this strategy, the birthing person listens to their body and their own cues for when, where, and how to push their baby out.

In physiologic pushing, the urge to push is undeniable. You can’t stop it if you tried! You will not be able to hold it back. Your body will start bearing down on its own when it is ready to do so.

Consider this scenario in the pushing stage:

What often happens instead is…

  • The doctor/midwife uses a cervical check to determine full dilation.
  • You reached 10cm! It’s time to push! Or is it…
  • Your provider might have you lay flat on your back in the bed and pull your legs up to push when they tell you to.
  • You might be pushing for quite a long time…especially for a first birth!
  • There is a much greater risk of exhaustion, slow descent of your baby through your pelvis, non-ideal positioning of your baby, pain & discomfort, interventions such as instrumental delivery (forceps/vacuum), cesarean, etc.

That sounds awful right?

Instead, try the following…

  • Wait to push until you can’t but push! Wait for the urge to bear down and for the fetal ejection reflex to kick in.
  • Once your cervix is fully dilated, if you aren’t feeling the urge… give yourself a break. Take a walk to the bathroom and go through some contractions on the toilet (the dilation station).
  • Avoiding an epidural helps because you can FEEL the urge to push and you can listen to your body. You can ask to turn it down.

Also, I would like to point out that we live in a world of synergy. Sometimes you may feel you need one of these strategies more than the other. What was YOUR pushing experience like?


If you want to learn more, I’m giving a FREE webinar called 5 Totally Doable Tips for a Healthy Pregnancy and Birth on January 27th at 7pm. In this webinar, I’m going to give you some totally doable tips to support your goal of a healthy pregnancy and birth. Learn nutrition hacks, how to support your microbiome, ways to incorporate natural movement, and relaxation strategies. Sign up and receive a FREE set of relaxation audio files!


Are you thinking…”tell me more!”?? Check out my ULTIMATE Holistic Birth Course.

In this course, you’ll learn everything you need to know in order to birth your baby in peace and power. I’m going to give you my expert insight based on years of experience as a doula, educator, and mother of four. You’ll receive expert level knowledge to help you radically transform your birth experience. 

Along with your childbirth education, you’ll also receive AMAZING resources to help you achieve your goal of a calm and confident birth (A $579 value!).

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