The second stage of labour or the pushing stage is the stage we see most often in the movies, in comedies and even in ‘reality tv’ series based in maternity hospitals. So we’ve been kind of conditioned to expect a certain scenario. Lying on your back in a hospital bed, feet in stirrups, being urged to hold your breath and ‘push down into your bottom’. Or even maybe to ‘get angry with your baby’. Sound about right? As a pelvic health physio, it makes me cringe. Babies often aren’t really big fans either.


For the baby, if you think about it really simply, they get their oxygen from their mum. So if their mum is holding her breath while pushing she is getting less oxygen and so is baby. Mums and babies can tire quickly during this type of pushing (commonly known as coached pushing) too. We know from research that babies born after coached pushing often tend to have lower APGAR scores. (This is the score used to assess the health of a newborn at birth. Higher scores mean healthier baby).

For the pelvic health physio, we tend to think of interventions in terms of how they may affect the pelvic floor. We know from research that coached pushing is assocated with:

  • More chance of having an episiotomy (cut to the perineum).
  • 25% more stress incontinence (leakage with coughs, sneezes, running, jumping and other activities.
  • DOUBLE the amount of destrusor activity. This means you’re twice as likely to experience ‘bladder instability’ (urgent and often very frequent need to pee, sometimes causing leaking on the way to the toilet).
  • Decreased first urge to void (less awareness of needing to empty the bladder as it fills). This can cause more urgent trips to the toilet.

Spontaneous Pushing

What’s the alternative then, you may be wondering. The research also seems to indicate that coached pushing doesn’t speed up a baby’s birth by much. Possibly about 15 minutes if at all. Most studies have found no benefits to coached pushing for either baby or mum.

The alternative is spontaneous (also called mother-led pushing). This means waiting until a mother reports feeling ‘an urge’ to push (trust me, you’ll know it when you feel it!) and then encouraging and supporting her to follow her body’s urges and push when it feels right. This allows the vaginal tissues time to stretch more gradually and your baby’s head to ‘mould’ to fit through more easily.

So, to summarise, babies love spontaneous pushing because it’s easier for them and that’s why mums and physios love it too! I’ll link to some more great articles and some research on spontaneous v coached pushing below. Then you’ll have some great information as a starting point when chatting through this information with your doctor or midwife.


A randomized trial of coached versus uncoached maternal pushing during the second stage of labor

Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials

Do maternal pushing techniques during labour affect obstetric or neonatal outcomes?

AIMS Ireland – Looking At The Evidence for Birthing Your Baby