How to Push a Baby Out, and the Misconceptions
Introduction: Why Pushing Deserves a Rethink
If you’re pregnant, you’ve probably already heard how you’re “supposed” to push. Someone told you to hold your breath. Someone else said you’ll just “know what to do.” Maybe a movie scene pops into your head—purple face, yelling, legs pulled back, everyone counting to ten. Or someone told you to just “breathe the baby down”. But what do all of these even mean?
Here’s the truth most moms don’t hear: pushing is not a single technique, and it’s definitely not an on/off switch. How you push matters—for your baby and for your pelvic floor.
As a pelvic floor physical therapist who specializes in birth prep, I see the downstream effects of pushing styles every day: prolapse symptoms, tailbone pain, pelvic floor tension, and lingering core issues that moms are told are just “part of motherhood.” They’re not.
In this post, you’ll learn:
The different ways to push a baby out
The difference between closed glottis vs. open glottis pushing
Why bearing down is not the same as straining
How pushing is really about volume control, not force
What the research actually says about safer, more effective pushing
This is evidence-based, mom-centered education—no fear tactics, no fluff.
The Biggest Misconception About Pushing
Pushing Is Not an On/Off Button
One of the most common misconceptions is that pushing is binary: you either push or you don’t. In reality, pushing is more like volume control.
Think of it like dimming a light instead of flipping a switch.
You can push gently. You can push gradually. You can increase or decrease intensity based on what your body and baby need in that moment.
This matters because the pelvic floor is not meant to clench and blast a baby out. It’s designed to lengthen, thin, and yield—much like a turtleneck rolling down rather than snapping open.
When pushing is treated like an all-or-nothing event, the pelvic floor often responds by tightening instead of lengthening, which can slow birth and increase tissue strain.
Understanding the Pelvic Floor During Pushing
Before we talk techniques, let’s ground this in biomechanics.
The pelvic floor is a hammock of muscles that must:
Lengthen eccentrically
Coordinate with the diaphragm
Respond to pressure, not fight it
Effective pushing happens when:
The diaphragm moves downward
The pelvic floor lengthens with that pressure
Abdominal force is directed down and out, not held in
This coordination is a major focus of pelvic floor physical therapy and intentional birth prep, because it doesn’t always come naturally—especially in a medicalized birth setting.
Closed Glottis Pushing: What It Is and Why It’s Often Used
What Is Closed Glottis Pushing?
Closed glottis pushing means the breath is held while pushing. The glottis (the opening between the vocal cords) is closed, trapping air in the lungs.
This style often looks like:
Deep inhale
Breath held
Forceful pushing for 6–10 seconds
Repeated with counting
Closed glottis pushing includes two very different patterns that often get lumped together—and that’s a problem.
Valsalva Pushing: High Force, High Risk
Valsalva pushing is a specific type of closed glottis pushing where a person bears down hard against a closed airway.
What’s happening biomechanically:
Intra-abdominal pressure spikes quickly
The pelvic floor reflexively contracts instead of lengthening
Blood flow and oxygenation can temporarily decrease
Research has linked prolonged Valsalva pushing to:
Increased pelvic floor strain
Increased fatigue and perineal trauma in some populations
The American College of Obstetricians and Gynecologists (ACOG) notes that directed, prolonged breath-holding pushing does not consistently improve outcomes and may increase maternal fatigue .
This is the “purple pushing” many moms fear—and with good reason.
Bearing Down: Closed Glottis, Done Differently
Here’s where nuance matters.
Bearing down is not the same as straining.
Bearing down can involve a closed glottis without aggressive force.
Key differences:
Pressure is gradual, not explosive
The pelvic floor lengthens instead of clamps
The abdominal wall supports rather than overpowers
Some moms naturally bear down with a brief breath hold, especially in late second stage, and that can be effective when the pelvic floor is already yielding.
The problem isn’t breath-holding itself—it’s how much force and how long it’s sustained.
Open Glottis Pushing: Breathing Your Baby Down
What Is Open Glottis Pushing?
Open glottis pushing keeps the airway open. Breath is released during effort, often as:
Slow exhale
Low moaning or sighing
Gentle vocalization
This approach:
Allows pressure to build gradually
Encourages pelvic floor lengthening
Improves oxygenation for both mom and baby
Instead of forcing the baby out, you’re breathing the baby down.
What the Research Says
A Cochrane Review comparing pushing techniques found that spontaneous, open glottis pushing is associated with:
Less maternal fatigue
Reduced perineal trauma in some cases
Similar or improved neonatal outcomes compared to directed pushing .
Another review in The Journal of Midwifery & Women’s Health emphasizes that physiologic pushing supports natural pelvic floor mechanics and maternal comfort .
In pelvic floor physical therapy, we favor open glottis pushing because it mirrors how the pelvic floor was designed to function—responsive, not resistant.
Pushing as Volume Control: What That Actually Looks Like
Let’s make this practical.
Early Pushing
Gentle exhales
Low effort
Focus on relaxation and descent
Mid Pushing
Increased abdominal support
Longer exhales
More intentional pressure
Late Pushing (Crowning)
Shorter, controlled pushes
Often instinctive
Less force, more finesse
This adaptability is why coached “count to ten” pushing doesn’t work well for everyone. Birth isn’t linear, and your pushing shouldn’t be either.
Why Your Birth Environment Matters
Even the best pushing strategy can be overridden by:
Being coached too early
Being rushed
Positions that restrict pelvic outlet movement
Side-lying, hands-and-knees, squatting, or supported forward-leaning positions often allow better pelvic floor lengthening than flat-on-your-back pushing.
This is where birth prep and pelvic floor physical therapy can be game changers—helping you practice these patterns before labor.
How Pelvic Floor Physical Therapy Prepares You to Push
Working with a pelvic floor physical therapist during pregnancy can help you:
Learn to lengthen (not just strengthen) your pelvic floor
Coordinate breath with abdominal pressure
Practice pushing strategies safely
Reduce fear around pushing
At enCORE Therapy, we work with moms across Kansas City and Overland Park to prepare their bodies—not just their birth plans—for labor.
Key Takeaways for Moms
There is more than one way to push a baby out
Closed glottis ≠ bad, but forceful Valsalva pushing can be problematic
Open glottis pushing supports pelvic floor lengthening
Pushing is about control and coordination, not brute strength
Preparation changes outcomes
Your Next Step
If you’re pregnant and want to protect your pelvic floor before birth—not just rehab it after—pelvic floor physical therapy is one of the most evidence-based tools you can use.
Whether you’re planning a medicated birth, unmedicated birth, or somewhere in between, learning how to push with intention matters.
Ready to prepare your body for birth, not just hope for the best?
Reach out to enCORE Therapy for expert-led pelvic floor physical therapy and birth prep in Kansas City and Overland Park. Your pelvic floor will thank you—long after birth.
