Laboring Down: To Push or Not to Push

What is Laboring Down? 

Laboring down is a period of not actively pushing when you are fully dilated after the second stage of labor begins. You read that right. You reach 10 cm, are fully dilated and you don’t push. Some women will wait 1-2 hours, letting their bodies do most of the work in getting baby further down the birth canal before actively pushing. When the baby is crowning or when they feel an overwhelming urge to push, then do they begin to start pushing.  

Other names for laboring down include “delayed pushing,” or “passive descent.” You may see that women who choose to labor down, more frequently experience the fetal ejection reflex (your body’s natural reflex that pushes the baby out for you; read about it here).

 In contrast, a lot of women will immediately begin to jump into the pushing phase as soon as they are fully dilated (10cm), they may even be coached to do so. This is called “immediate pushing.” The difference between the delayed pushing group and the immediate pushing group is when they start actively pushing. 

What is Fetal Station? 

It is preferable for baby to be in a positive station for active pushing, which makes sense. It would be easier to push a baby out when they are nearer your vaginal opening and not still high in the pelvis.  By laboring down or delaying pushing, allows your uterus to work for you until baby is in a more positive station, you avoid maternal mental and physical exhaustion, by decreasing active pushing time. 

Fetal station is tricky, because you cannot just know where your baby is at. Often through cervical checks healthcare providers can roughly feel about where the baby is, but it is still subjective to your healthcare provider. Two providers could give you different numbers, since they are taking an educated guess about the baby’s station. There are also pros and cons to frequent cervical checks. If you would like more information you can check out naturalwomanhood.org and the American Journal of Obstetricians and Gynecologists (AJOG). 

What Does the Research Say About Laboring Down? 

The research regarding laboring down is very interesting and a little confusing. In 2016 the Cochrane review came out saying: “women should be encouraged to push and bear down according to their comfort and preference. Delaying pushing for women with epidural reduces the time spent pushing when giving birth, and increases the likelihood of a spontaneous vaginal birth. However, it increases the duration of the second stage of labor.” 

An Additional study done in the United States came out related to first time Moms in regards to laboring down. In 2017, The American College of Obstetricians and Gynecologists (ACOG) published an article in favor of laboring down and gave evidence to support it. However, then in 2019 they quickly changed their stance on laboring down. It was a whiplash for many in healthcare, to go back and forth so quickly. 

The updated available evidence changed to: women should begin pushing at the start of the second stage of labor for nulliparous women (first baby for Mom) receiving neuraxial analgesia (epidural). Delayed pushing has not been shown to significantly improve the likelihood of vaginal birth and risks of delayed pushing, should be shared with nulliparous women receiving neuraxial analgesia who consider such an approach. Yet there isn’t any mention of women who have had multiple births or multiple births while on an epidural, or unmedicated births and first time Moms. 

So there are risks involved with delayed pushing that women should be informed of, yet ACOG seemed to predominantly focus on women who were first time Moms while on epidurals in their study. I found that a little confusing, so I’d like to give you more of the benefits and risks so you can make your own informed decision. An interesting find though, was that numerous other studies agree the greater the length of active pushing, the increased risk of cesarean section.

What are the Benefits of Laboring Down? 

Many women who have birthed at home, birth centers, or in the hospital setting have labored down and tout the benefits to include: 

• Allowing your body to work for you
• Actively pushing for a shorter amount of time
• Less physical and mental strain
• Possibly reducing the need for a Cesarean Birth. 
• Reducing the need for instrument assisted delivery (forceps, the vacuum method, etc.)

Many women enjoy laboring down with epidural analgesia, as epidurals help relieve pain, without losing all ability to feel. While on an epidural, you won’t stay in the supine position (on your back), but alternate between different positions, turning from side to side, to ensure that baby keeps moving down the birth canal. By waiting until baby descends lower in your pelvis, the birthing Mom can utilize the epidural anesthesia and rest, until needing to actively push or feels the need to do so, relieving maternal fatigue. 

If the epidural is a heavier dose, and women cannot tell when to push, they can still be coached by their birth team, partners, or healthcare providers when baby is closer to vaginal delivery.  

If you are wondering if an epidural is for you, you can read more information here. 

Many birth professionals, birthing mothers, and even lamaze international share positive experiences with no complications in relation to laboring down, with  lamaze international stating: 

“Pushing is hard work, and while many women find it satisfying to begin working with their contractions by pushing, it can be helpful to allow yourself a span of time to let your body do the work naturally before exerting the energy it takes to push out your baby. First-time moms may push for 1-3 hours, or it could be 10-20 minutes. And because it’s impossible to predict the amount of time you’ll spend pushing, laboring down is an effective way to help you conserve energy by reducing the amount of time spent actively pushing.”

What are the Risks to Laboring Down? 

Since we cannot predict what will happen in birth there are risks that can occur. There have been only a few studies that show a slight increase in the following adverse effects with laboring down, including:

• Longer overall labors as you may be “waiting” for a period of time before you feel the need to push (though this did not seem to be by a significant amount between accounts)
• Slight increase in Chorioamnionitis, a bacterial infection in the sac and fluid around the fetus (Some have looked into this and wonder if it could be related to how often cervical checks are done on the mother when she is in active labor)
• Slight increase in postpartum hemorrhage (heavy bleeding after giving birth)
• Slight increase neonatal acidemia (a newborn’s blood being too acidic)

 If you would like to learn more about advocating for the labor you want, you can learn more about informed consent and your right to refuse any medical treatment that you don’t agree with in our article. 

Final Thoughts

Laboring down, or delayed pushing for one to two hours after reaching 10 cm may help baby to descend to lower stations more naturally and reduce active pushing time. Overall, first time Moms on an epidural considering laboring down, may need to consider the American of Gynecologists and Obstetricians evidence. Yet, for many women, they testify of the power of “hurrying up and waiting.” Allowing their body to naturally push baby down and saving their energy for the time to actively push when it is needed most. 

I hope that through learning the risks and benefits of laboring down you will feel like you can make an informed decision for yourself and your baby. I wish I had known a few of the things in this article when I was delivering in order to have made informed choices. The good news is that having knowledge is power and by working with your birth team including your healthcare provider, delivery nurse, birth doula, or partner you can make a clear birth plan that is tailored just for you.