Preparing To Push – Learning How To Push During Birth

“Hold your breath and I will count to 10 – keep pushing until I stop counting”. “Push like you are having a bowel movement”!  What?  So you want me to hold my breath and poo my baby out?

My idea of pushing before I had my children was what I learned from TLC Baby Story – on your back, feet in stirrups, knees by your ears and someone counting to 10 while you held your breath and went purple.  I thought that was how it was done.  Thankfully I read and researched and asked and learned that what they show on TV is one of the worst positions to give birth in.  A woman on her back has to work against gravity, the space in her pelvis is restricted meaning she has to push harder and with her knees pulled back she is pushing through a very tight, stretched perineum and is more likely to tear.  Wouldn’t it be nice to know how to make it easier rather than harder?

Birth is a very physical event that takes mental and physical stamina.  By training your mind and body during your pregnancy you will be better prepared for one of the most amazing events in your life!  Your body was designed to give birth.  Your body knows how to give birth, the urge to push is natural however with some knowledge and awareness before birth, you can help prepare your body to facilitate the birthing process and be set up for a smoother recovery postpartum. By thinking about optimal birth positions, doing preventive perineal care and practicing breathing women can prepare their mind and body for birth and minimize the likelihood of intervention.

Birth positions can greatly influence the progression of labour and birth. Upright positions and movement during labour help the baby move down into and out of the pelvis.  When the body is upright your sacrum is free to move and help create space for the baby as he/she moves down.  Squatting uses gravity and helps keep the pelvic outlet open during labour.  Supported squatting using a partner or a birth ball make this position even better by taking some of the strain off the perineum.  Side lying, while not as upright, does allow for a nice open pelvis and is one of the best positions in terms of preserving the perineum.

The perineum is the area between the vagina and the anus and is vulnerable to tearing during delivery.  In some cases it may even be cut (an episiotomy) to expedite the delivery.  Neither is ideal, however tearing is better than an episiotomy.  By preparing the perineum prior to delivery you can reduce the likelihood of tearing.  Perineal massage is a great option and can be done on your own or by a partner.  Another option is a product called the EPI-NO (short for No Episiotomy).  It is used daily to help strengthen and lengthen the muscles of the pelvic floor and prepare the perineum for birth.  By combining breath work and visualization with either perineal massage or the EPI-NO, you can truly connect with your pelvic floor and help ease the passage of your baby into the world.

Breath is key during birth.  It helps alleviate pain, it brings oxygen to your baby and your tissues and it can help keep your pelvic floor relaxed.  Breath holding and jaw clenching, which is common when experiencing pain, correlates with a tight and clenched pelvic floor – not ideal when you are trying to push your baby out.  In an ideally functioning core, the pelvic floor lifts and contracts with each exhale, however, during birth it is ideal to exhale with the contractions and urges to push so you should practice learning to relax your pelvic floor on the exhale in the last few weeks of pregnancy.   Being able to relax your pelvic floor is critical when it comes time to give birth.

In other posts you have seen the core breath which you should practice during pregnancy and immediately after birth.  During the last few weeks of your pregnancy however, I want you to do the reverse core breath.  Instead of ‘Inhale to Expand’  ‘Exhale to Engage’, you will Inhale to Expand’ and ‘Exhale While Staying Expanded’ keeping space between your sitz bones.  Using the biofeedback gauge on the EPI-NO is especially helpful because it allows you to see if and when you are contracting and if and when you are relaxing – enhancing the mind/body connection during pregnancy so you and your body know better what to do during birth.

During the actual birth use your breath with the natural urges to push rather than someone telling you when to push.  Try not to hold your breath but rather exhale through each contraction.  As your baby’s head is crowning send your breath to where you feel the resistance and don’t push – you will feel intense stretching and pressure but just breathe, create space and allow the tissues to gradually expand.

By preparing to push using your breath, your body and your mind, you will help facilitate the arrival of your amazing child into the world.

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Kim Vopni
Kim Vopni The Fitness Doula – Author of Prepare To Push™ - What Your Pelvic Floor and Abdomen Want You To Know About Pregnancy And Birth, Owner of Pelvienne Wellness Inc, and Co-Founder of Bellies Inc. Kim is a mom of 2 boys and is a Certified fitness professional who also trained as a doula. She combines the support aspect of a doula with the principles of fitness to help her pregnant clients ‘Prepare To Push’ while postpartum she helps her clients optimize healing and regain their core confidence for motherhood. She has taken specialized training in 2 pelvic floor fitness programs - the Pfilates Method and the Hypopressive Method. In 2009 she created a women’s health event called Kegels and Cocktails (that is now running across Canada and into the USA) designed to empower and educate women on the importance of pelvic health. You can find her on-line at and on facebook @PelvienneWellness and @BelliesInc and on twitter @FitnessDoula and @BelliesInc Kim is also a contributing writer for the Globe and Mail's online Health section.
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  • Lauren Rapp Kimbell

    Where can I find more info on what to do during crowning? This is my fourth labor and the crowning pushing is still a mystery to me of what is best to do. It seems I just panic when it’s time to push, so I push harder and faster to get it over with. Looking for another way, Help!

    • Aida Nasser

      Thank you Lauren for your great question. We’ll reach out to our team and get back to you with a response as soon as possible.

    • Aida Nasser

      Dear Lauren,

      Please find below Kim Vopni’s response to your question. A fitness doula, Kim is one of MG’s key contributors:

      “Ideally during crowning you are not pushing. You are breathing and visualizing space and openness while resisting the urge to push or to grip. This is the time we need slow controlled breathing to allow the perineum to stretch gradually as the baby’s head is crowning.

      Warm cloths and counter pressure on your perineum can be helpful (performed by your midwife – not all doctors will do this).” – Kim

      I hope this helps. Good luck.