Giving Birth: To Push or Not to Push?

Mama pushing

When your labor advances, and your baby is ready to move down the birth path, will your medical provider instruct you to hold your breath and push?  Or, will you be allowed to work with your pulsating uterus and gently breathe your baby down and out?

In today’s environment of hospital births, most medical care providers encourage (and sometimes, force!) their patients to use the Valsa maneuver once the birthing mother’s cervix is 10 centimeters open.  The Valsa technique occurs when a doctor or other individual tells the mother to hold her breath through the count of ten, while bearing down as forcefully as possible.  This method of pushing is commonly referred to as “purple pushing”, since a mom can turn purple from holding her breath and pushing so hard.

The Valsa technique was developed in the 1930s as a way to test pressure with the ears.  However, its use in obstetrical care quickly became routine, despite a lack of proof showing its benefit.  More than 12 studies have focused on the Valsa technique, and none have found any medical benefit to the forced pushing and straining, in terms of releasing the baby from the birth path faster, easier, or with fewer complications.  However, it is postulated that heavy straining can actually have a negative effect by tightening the vaginal tissues and closing the vaginal outlet, thus slowing the descent of the baby.  Further, forceful pushing can create damage to the pelvic floor and other organs, such as the bladder, sometimes causing trauma or prolapse.  And, it’s not hard to imagine that while “purple pushing”, the oxygen supply is severely limited to both mom and baby.

If “purple pushing” is not the ideal way to birth a baby, what options do mothers have?

HypnoBirthing, a way of giving birth using hypnosis founded by Marie Mongan, encourages birthing mothers to instead “breathe the baby down” by gently breathing while trying not to create tension in the body, which could tighten the birth path and make the vaginal outlet less receptive to the baby’s descent.  HypnoBirthing encourages the mother to allow her body to function as nature intended and follow the spontaneous uterine waves that move through her body, and use her breath to nudge the baby down the birth path, without added force.  The body performs rhythmic spontaneous waves of downward pressure during birth, which is called the Natural Explusion Reflex (NER).  It is these NER waves which allow women in comas to deliver their babies without any coached forceful pushing.  According to Marie Mongan, “There actually is pushing involved with this approach, however the mother does not intentionally add to the bearing-down efforts that her body makes on his own, nor does she hold back.”  Forceful pushing creates tension, thus creating pain and fear, which slows the baby’s descent, prolongs the pushing phase, and creates discomfort.

A study conducted in 1957 showed that “when women were allowed to push without straining, better progress and greater ease [that] has to be witnessed to be believed” and less damage to the vaginal tissues.  A study from the University of Texas, South Western Medical Center came to the same conclusion in 2006.

The complication is that not all women feel the NER bearing down reflex.  A woman birthing without medication feels the NER very strongly.  However, moms on an epidural do not have sensation, therefore are unable to feel the NER sensation.  Just like a woman in a coma though, just because the sensation can’t be seen by bystanders or felt, does not mean that it is not occurring within the birthing body.

Medical care givers should give a birthing mother the chance to gently breathe their babies down, allowing her to tap into the natural ability that her body has to nudge the baby out of the uterus, through the birth path to crowing, and finally, give birth.  In most cases, parents will need to request that their care giver allow them the opportunity to try breathing the baby down, before agreeing to Vasla “purple pushing”.

To learn more about HypnoBirthing, the NER reflex, and breathing you baby down gently in labor, visit

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