When it comes to childbirth in movies, we often witness scenes of mothers lying on their backs in delivery beds, doctors positioned between their legs, while other characters (midwives, nurses, fathers) enthusiastically direct them to push harder and hold their breath. Surprisingly, this depiction aligns with reality in many hospitals worldwide. But the pressing question is: Is holding your breath while pushing really necessary? Would babies not be born, or would labor be more challenging without constant coaching? In this post, I address these inquiries and delve into effective pushing techniques and the crucial art of breathing during the pushing stage.

So is coaching during the pushing phase necessary? Does someone really need to tell mothers what to do, when to push, how to breathe? Typically in hospitals, mothers are not just told when to push but also instructed to hold their breath for the count of ten… and push with all their might while holding their breath. But this is actually a very old-fashioned practice, and definitely not the easiest way and not the best for your baby or for you! Because when you hold your breath for a longer time, your face starts turning purple within a few seconds because you simply have less oxygen available! But of course, this oxygen isn't just depleting in your body, but much less oxygen reaches your baby too and it can easily lead to the decrease of the heart rate of the baby. This can then escalate birth into a rush… your provider might tell you to push even when there's no contraction, because the baby needs to be born as soon as possible...

So how can you avoid this? First of all, you need to signal to your provider that you do not want to be coached during the pushing stage but to push spontaneously, according to your instincts and to react to your sensations. Secondly, instead of holding your breath, try to activate your muscles while you are exhaling! And at first, this may sound strange because we have so deeply rooted the image when mothers are pushing while holding their breath, but just think now of weightlifters… They make funny sounds when lifting the dumbbell because they are exhaling! But how does this help the pushing? To answer this, let us now do a quick trial, and let us compare how it feels to push when holding your breath and how it feels to push while exhaling! Now first try to hold your breath for just a few seconds and activate your abs while holding your breath… What do you feel? Well, you are activating just your abs while holding your breath, almost as if squeezing the toothpaste in the middle. However, we usually want to squeeze the toothpaste from top to bottom! So let us now try to activate the abs while you are exhaling! What do you feel now? Did you feel that – even without thinking - you are pushing downwards too, like when squeezing toothpaste from the top towards the bottom? And that is exactly why bearing down while exhaling is more efficient! You are not only activating your abs but also your diaphragm, and your diaphragm is helping your uterus to push the baby outwards! The second benefit is that neither you nor your baby is deprived of oxygen as you are not withholding your breath, and the third benefit is that if your glottis is open too – so your throat is relaxed - while you are exhaling, then your pelvic floor is relaxed too and that limits the chances of perineal tearing! And how can you make sure your throat is loose while exhaling? It is very simple... just  vocalize and make some sounds! This typically feels very good anyway, so just do not refrain from making deep mooing sounds while you are bearing down! 

Now during this exercise, we exhaled through the mouth... but actually, you can also exhale through your nose if that feels right for you, and you can even make a humming sound while exhaling through your mouth! Take a moment to try this!

And what if, despite all that, you instinctively still hold your breath while pushing... do not worry, that is fine too! There is no one-size-fits-all solution for breathing; we are all different. So the best is to listen to your body and react to your sensations, and to do what feels right for you in that very moment! The most important thing is to not have somebody else dictate how long you should hold your breath but to do it in a way that feels right for you! So keep listening to your body and breathe when you feel it is necessary to breathe, as even if you withhold your breath, instinctually you will not do this longer than five to six seconds, and that does not yet cause oxygen deprivation – unlike withholding your breath for a count of ten!

And how can you rehearse for the breathing of the pushing stage? Well, there is a very ideal moment for that: when you sit on the toilet! As an expectant mother, you probably spend quite some time there... so make the best of it and practice breathing simply while you're pooping! Try to push while you are exhaling, try to exhale through your mouth, through your nose, and make sounds while breathing out; thus, prepare yourself a bit for the pushing phase too!

Enjoy your pregnancy!