When it comes to pushing in labour, one truth stands above everything else:

Women are the experts in their own births.

Yet in many maternity settings, women are routinely told when to push, how to push, or not to push at all. These instructions often override instinct and research shows they can even cause harm.

The Problem with Directed Pushing

Despite clear evidence against it, directed pushing remains standard. But studies link it with:

For mothers
• less effective contractions
• increased fatigue and acidosis
• longer pushing phases
• more perineal trauma

For babies
• disrupted rotation and descent
• hypoxia
• increased need for resuscitation
• higher special care admissions

One major study concluded:

Directed pushing increases the length of second stage and the risk of adverse neonatal outcomes.

Yet the typical pattern still unfolds:

Directed pushing → baby becomes hypoxic → woman urged to push harder → baby becomes more distressed instrumental birth mother believes her baby was “saved”.

We can and must do better.