Effective Pushing Strategies for Childbirth

Childbirth is an intense and transformative experience, and understanding different pushing techniques can help you feel more empowered during the process. There are two main types of pushing strategies: open-glottis (exhale) pushing and closed-glottis (breath-holding) pushing. Each approach has its benefits and potential downsides. Below, we’ll dive into both methods to help you find a strategy that supports a safe, positive birthing experience.

Open-Glottis Pushing

What It Is:  

Open-glottis pushing, often called “exhale pushing” or “breathing your baby out,” involves taking a breath and then gently exhaling while bearing down and pushing. You aim to push for about 6-8 seconds, exhaling as you go, and repeat this 2-3 times per contraction.

How to Do It:

1. When you feel a contraction, take a deep breath in.

2. As you push, gently exhale for 6-8 seconds while focusing on lengthening and relaxing your pelvic floor.

3. Repeat 2-3 times per contraction as needed.

Benefits:  

- Reduces Strain: This technique is typically less strenuous, which can help conserve energy for the entire labor process.

- Relaxes the Pelvic Floor: Open-glottis pushing encourages relaxation of the pelvic muscles, which can help reduce muscle resistance at the vaginal opening, making it easier for your baby to descend.

- Positive Birth Experience: Many people find this technique less intense and exhausting, leading to increased maternal satisfaction.

Considerations:  

- Longer Labor: Open-glottis pushing may take longer for the baby to descend, which some hospital staff may not be as familiar with or confident in supporting.

- Encourages Natural Pushing Urges: This technique allows you to push in response to your body’s instincts rather than a set rhythm, which may not be ideal for certain high-risk situations.

Closed-Glottis Pushing

What It Is:  

Closed-glottis pushing, or “breath-holding” (also known as the Valsalva maneuver or “purple pushing”), involves taking a deep breath, holding it, and bearing down forcefully. This is a directed pushing strategy often coached by a healthcare provider, where you hold your breath for 10 seconds and push, repeating 2-4 times per contraction.

How to Do It:  

1. Take a deep breath as the contraction begins.

2. Hold your breath while bearing down for a count of 10 seconds.

3. Exhale briefly, then repeat this sequence 2-4 times or until the contraction ends.

Benefits:  

- Increased Pushing Force: Holding your breath helps build abdominal pressure, which can produce more powerful pushes, often speeding up the descent of the baby.

- Beneficial in Certain Situations: Closed-glottis pushing is sometimes recommended if labor needs to progress quickly for maternal or fetal safety reasons, especially when other techniques aren’t effective.

Considerations: 

- Higher Risk of Pelvic Floor Damage: Prolonged use of this technique can increase the risk of pelvic floor injury and perineal tearing due to the added pressure on these muscles.

- Exhausting Over Time: Closed-glottis pushing is intense and may lead to quicker fatigue. This is one reason it’s often recommended only for certain stages rather than for prolonged use.

Choosing the Right Strategy

In some cases, healthcare providers may recommend combining these approaches or using one intermittently to adjust the baby's position or respond to how your labor is progressing. Keep in mind that your body’s cues matter, and your healthcare team can support your choice based on your specific needs and labor experience.

Unsure where to start? Our Birth Prep Sessions can help you feel confident and prepared!

If you’re currently pregnant, our birth prep sessions are designed to help you feel ready, informed, and calm as you prepare for your new arrival. Here are some strategies we review during these sessions:

- Positioning for Baby’s Descent: Learning optimal labor and delivery positions can help open the pelvis and allow your baby to descend more easily. We’ll explore the levels of the pelvis and encourage your partner to join, ensuring you both feel prepared and confident. Your birth partner can also provide continuous labor support, helping you with comfort measures and encouragement.

- Reducing Injury Risk: Strengthening and relaxing your pelvic floor in advance can help reduce the risk of orthopedic, pelvic floor, and nerve injuries during delivery. We’ll review effective techniques for both internal and external pelvic floor relaxation, essential for preparing for a vaginal birth.

- Breathing Mechanics & Push Preparation: We can help teach you how to effectively use both open-glottis and closed-glottis pushing techniques by focusing on optimal pelvic floor engagement and relaxation. Through guided exercises and coaching, you'll learn to coordinate your breathing and abdominal pressure while minimizing strain on your pelvic floor, helping reduce the risk of injury and improving the efficiency of each push.

How we can help 

Childbirth can be unpredictable, but working with a pelvic floor PT before childbirth can help reduce the risk of pelvic floor injuries, promoting a smoother and safer delivery experience. With personalized guidance, pelvic floor therapy can empower you to navigate the pushing stage with confidence and control. To learn more about our birth prep sessions, click here.