Why Open Glottis Pushing Supports Your Pelvic Floor
When it comes to pushing during labor, one technique could protect your pelvic floor—and the other might work against it. Most hospital births in the United States default to what’s called “closed glottis pushing”—also known as “purple pushing,” where you take a deep breath, hold it, and bear down hard, often while on your back. But just because it’s the norm doesn’t mean it’s what’s best for your body or your baby.
Enter: open glottis pushing—a more physiological, intuitive, and pelvic floor-friendly way to push. This method aligns better with the body’s natural mechanics, breathing patterns, and hormonal rhythms. In this blog, we’ll break down what open glottis pushing is, why it’s better for your pelvic floor, what the research says, and how you can advocate for it—even in settings where it might not be the standard.
What is Open Glottis Pushing?
Open glottis pushing is a technique where you push while exhaling, not while holding your breath. You might grunt, moan, or vocalize as you bear down with each contraction. It mirrors how you might push during a bowel movement. The key is that your glottis (the opening between your vocal cords) stays open, allowing you to breathe and release sound during the push.
Compare that to closed glottis pushing, where you’re instructed to:
Take a deep breath,
Hold it (essentially performing a Valsalva maneuver),
Tuck your chin to your chest,
Push as hard and as long as you can—typically for a count of 10.
This style of pushing is often coached and imposed, especially in hospital settings where staff may be under pressure to keep things moving along. But there’s a growing body of evidence showing that open glottis pushing is safer and more effective—especially when it comes to protecting your pelvic floor.
The Pelvic Floor Needs Oxygen Too
As a pelvic floor physical therapist in Kansas City, I’ve seen countless postpartum clients dealing with the consequences of excessive force during the second stage of labor. One of the biggest contributors? The sustained intra-abdominal pressure that comes from breath-holding while pushing.
During closed glottis pushing, you’re building up enormous pressure inside the abdomen, which is then directed downward onto your uterus, pelvic floor, bladder, and rectum—all while your baby is trying to navigate the birth canal. This can lead to:
Perineal tearing
Pelvic organ prolapse
Rectal trauma
Long-term incontinence
A 2017 study in the American Journal of Obstetrics & Gynecology found that open glottis pushing led to significantly fewer perineal injuries than closed glottis pushing. That’s huge. Why? Because when you push while breathing out, you reduce pressure spikes in the pelvic cavity. Your body is working with the contraction, not overpowering it.
Open Glottis Pushing Works With Your Body's Reflexes
Pushing with an open glottis is more in tune with your Ferguson reflex—the body’s natural urge to bear down when the baby’s head is low in the birth canal. This reflex is triggered without you needing to consciously strain. It’s a reflex for a reason—your body knows what to do.
By contrast, closed glottis pushing often starts before your body is ready. Staff may instruct you to push just because you're 10 cm dilated, regardless of fetal station or your own physical urge. But dilation alone doesn't mean it's go-time. If the baby’s head is still high, early pushing can lead to swelling of the cervix, prolonged second stage, and more trauma for you and baby.
Letting your body guide the process can actually shorten the pushing phase, even though it may seem slower to observers. It reduces fatigue, lowers the risk of fetal distress, and supports a smoother descent.
Hospitals Often Default to Closed Glottis Pushing (But You Don’t Have To)
Unfortunately, many hospitals—especially in Kansas City and Overland Park—still default to closed glottis pushing because it’s what providers were trained in, it fits the institutional pace, and it can be easier to manage from a monitoring standpoint. You might be on your back, strapped to a monitor, and encouraged to push hard with every contraction whether you feel ready or not.
This is where your voice matters.
Yes, it might feel uncomfortable to push back (pun intended!)—but advocating for open glottis pushing is one of the best things you can do for your birth experience. If your care team isn’t supportive, consider involving your partner, doula, or physical therapist to help explain your wishes ahead of time. You are allowed to say:
“I want to wait until I feel the urge to push.”
“I’ll be using open glottis pushing with vocalization.”
“I need to be in a position that allows me to breathe and move freely.”
If you’re in the Kansas City or Overland Park area, consider visiting enCORE Therapy for a prenatal session. At enCORE Physical Therapy, we regularly work with birthing people to create personalized, evidence-based birth prep plans—including coaching on how to advocate for your pelvic floor in labor.
What the Research Says
Beyond anecdotal experiences, research consistently supports the benefits of open glottis pushing. Let’s look at the data:
A study published in Birth found that women who used open glottis pushing had lower rates of pelvic floor dysfunction 6 months postpartum compared to those who used closed glottis pushing.
The Cochrane Database of Systematic Reviews reported that delayed and spontaneous pushing reduces maternal fatigue and results in better outcomes for both mom and baby.
Studies also show higher Apgar scores for babies whose mothers used spontaneous, open glottis pushing—likely due to less fetal distress from decreased pressure and oxygen restriction.
All of this reinforces what we already know from a pelvic floor therapy perspective: the less you force, the more your body flows.
Real Talk: It’s Okay To Make Noise
Let’s talk relatability for a second. Moms often tell me, “I don’t want to sound like a cow in labor.” But here’s the deal—making noise helps.
Low, guttural vocalizations help relax the pelvic floor. High-pitched, tense screams? Not so much. If you’re breathing out and moaning or grunting while pushing, that’s a good sign. You’re not “losing control”—you’re actually tuning in to your primal, physiological rhythm.
If you're working with a pelvic floor physical therapist, we can practice pushing positions and breath strategies before labor, so you feel empowered instead of overwhelmed. We even go over how to work with your birth team so you’re not second-guessing your instincts in the moment.
Takeaways You Can't Afford to Miss
Open glottis pushing supports the pelvic floor, reduces injury, and is in sync with your body's natural reflexes.
Closed glottis pushing increases pressure, which can lead to tearing, prolapse, and other long-term complications.
Just because you're in a hospital doesn't mean you have to go with the flow. You can push back, advocate, and take up space.
Vocal pushing is not only allowed—it’s effective. Don’t let embarrassment override physiology.
If you want professional support with birth prep and pelvic floor mechanics, pelvic floor physical therapy in Kansas City and Overland Park through Encore Therapy is here to help you every step of the way.
Where to Go From Here
Want to learn how to prepare your pelvic floor for birth and advocate for yourself in a hospital setting? You don’t have to do this alone.
📍 Check out Encore Physical Therapy for specialized support in Kansas City and Overland Park.
📚 Read more about hospital birth advocacy from Evidence Based Birth.
📘 Learn how to advocate for physiologic pushing with this Cochrane Review summary.
Let’s stop treating pushing like a performance and start treating it like the physiological, embodied process it was designed to be. Whether you’re birthing at home, in a hospital, or in a birthing center, your body deserves respect. And so does your pelvic floor.
