For most people, the way they envision women ‘pushing’ in the second stage of labour is through ‘directed pushing’ – where the woman is quite literally directed to push by caregivers. However, this is not always the case for all women in the second stage of labour.

So what are the Directed Pushing vs Spontaneous/Breathing Bearing Down methods?

DIRECTED PUSHING – Pushing without the woman necessarily feeling the urge to push.  The mother is instructed to take a big inhale, hold her breath and maintain a steady pushing effort for approximately 10 counts, 3 or 4 times through each contraction. Also known as ‘purple pushing’ or ‘valsava pushing’. 

BREATHING BEARING DOWN – Also known as ‘instinctive pushing’ or ‘mother-directed pushing’. The woman works with the ‘foetal ejection reflex’ and bears down when she feels an uncontrollable and instinctual urge and is not coached by caregivers unless assistance is asked for.

The aim of Hypnobirth is to empower you to approach birth with knowledge and information so that you can ask your caregivers relevant questions to achieve the birth you want. 

In terms of ‘pushing’ and the second stage of labour – some questions you can ask your caregivers.

• ‘Is spontaneous or directed pushing your standard practice?’
• ‘In what circumstances are the different methods used?’ 

Knowing your options and being able to ask the relevant questions prior to your birth will allow you to feel empowered and confident as you approach your birthing day. 

See the links below for a list of recent studies on Spontaneous vs Directed Pushing in the second stage of labour. 

FURTHER RESOURCES

• Maternal and neonatal outcomes from a comparison of spontaneous and directed pushing in second stage https://www.sciencedirect.com/science/article/pii/S1871519218304025
• Pushing: leave it to the experts https://midwifethinking.com/2014/04/16/pushing-leave-it-to-the-experts/?fbclid=IwAR1FnnI2ODZDLi3EPv3JOcGbtT9NnUNFa0rYuAfz289yzUzxQ8psvI0_zx4
• When and How to Push: Providing the Most Current Information About Second-Stage Labor to Women During Childbirth Education https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804305/
• A randomized trial of coached versus uncoached maternal pushing during the second stage of labor https://www.sciencedirect.com/science/article/pii/S0002937805008707
• Effect of breathing technique of blowing on the extent of damage to the perineum at the moment of delivery: a randomized clinical trial https://www.scopus.com/record/display.uri?eid=2-s2.0-85044621644&origin=inward&txGid=833113110c74cd69f7563e6c9677a9d7
• A randomized trial of the effects of coached vs uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function https://www.sciencedirect.com/science/article/pii/S0002937804020253
• The influence of maternal bearing-down efforts during second stage on fetal well-being https://doi.org/10.1111/j.1523-536X.1979.tb01298.x
• The impact of Valsalva’s versus spontaneous pushing techniques during second stage of labor on postpartum maternal fatigue and neonatal outcome https://doi.org/10.4103/1658-631X.137000 
• A descriptive analysis of involuntary bearing-down efforts during the expulsive phase of labor https://www.sciencedirect.com/science/article/pii/S0884217515326538