Coached pushing or passive descent?

In labor a cervix dilates from completely closed to 10 centimeters. When the magic number of 10 is announced after a vaginal exam it means the body has moved into the second stage of labor, PUSHING. The pushing stage for a first time parent can last 30 minutes to 3 hours on average. When it comes to pushing what options do you have? What is the difference between coached pushing and passive descent?

Let’s find out……


What exactly is it?

This is when a nurse, midwife, doctor, or other support person helps guide the laboring person through the pushing stage. It is usually comprised of encouraging the birthing person to take a deep breath and hold it, then push for as long as they are able at the peak of the contraction. Then come back and do that 2 more times before the contraction is over. After the contraction passes the time before the next is for relaxing.

What are the positives to coached pushing?

  • Everyone takes a few pushes to get the hang of what muscles they are using and how to do it. Being coached through this may be ideal to know if you are being effective or not.
  • If you cannot feel a strong urge to push to due some medical pain relief, guidance may be helpful.
  • When you are exhausted.
  • If you like it and it’s working for you!
  • Holding your breath can help you guide your energy. What the heck do I mean? Well once a wonderful Labor & Delivery nurse gave me this visual and I think its an excellent example. Ever talk on the phone while going to the bathroom? (We all do it don’t feel bashful.) Well imagine your bowel movement is ready to make its exit while you are still on the phone. You would, quietly, bear down while holding your breath, heaven forbid you made a noise that was a giveaway to what you were doing! That’s the push that can be useful!
  • Holding your breath can push the diaphragm down on top of the uterus helping with the pushing.
  • The guidance can be gentle reminders of what to do or loud directions, whichever you find fits what you need in that moment.

What is not so cool about coached pushing?

  • Often times this pushing can begin the second it is realized the cervix reached 10cm without an urge to push. This may cause the laboring person to do more work to bring the baby down the birth canal since there is no help of the body giving that strong urge.
  • If the laboring person is feeling discouraged because they aren’t seeing or hearing progress.
  • If the laboring person feels it goes against what their body is telling them.


What is this all about?

Have you ever heard of “laboring down”? This refers to continuing to labor until the urge to push is felt, even if the cervix is already fully dilated to 10cm. Laboring down is allowing the labor to continue to do its work of moving the baby down the birth canal without the birthing person exerting themselves too. Once the urge presents itself the laboring person follows their instincts on when to push and when to rest.

What’s so great about passive descent?

  • This is one way to truly letting the body do its thing and let the labor unfold in its own time.
  • The laboring person may feel more in control.
  • If you are exhausted, listening to your body may allow for a little more rest.
  • Just like coached pushing if you hold your breath when you push you experience those same benefits!
  • If this speaks to you more and you like pushing this way.

Why would passive descent not be a good fit?

  • The laboring person isn’t effectively pushing without any suggestions.
  • The care provider deems there needs to be a change due to some sort of concern.
  • The laboring person feels lost and like they don’t feel secure in what they should be doing.
  • If after laboring down a bit there is still no urge to push.

BUT GUESS WHAT! There’s a third popular option! It is actually doing a COMBINATION OF THEM BOTH! Using both of these techniques can be just what is needed in the pushing stage. Maybe at first some coaching to get into the groove of things is fitting. Then as you get the hang of it you take over and do what feels right.

There is no right or wrong here, just options! You may have an idea of what you want and what speaks to you. If the day of birth you realize you need something else that is totally OK. You can change your plans. You can always speak up and say what your preferences are. Your doula can be a great resource for helping you navigate what feels right at this point too. Level of energy, sensation, and personality all play a role on what is the perfect fit for you.

Still have more questions? Contact us today!

Authored by: Andrea Stainbrook

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