Empower Clients with 7 Effective Pushing Strategies for Birth

As pelvic health therapists, few interventions have a greater potential to change birthing outcomes than teaching clients how to push effectively. Yet, very few childbirth educators or hospital teams actively coach pregnant individuals on how to truly lengthen, not tighten, their pelvic floor muscles before birth. This is where we come in.

Today, I want to share with you several evidence-informed pushing strategies to help you guide your clients toward smoother births and faster recoveries.

Early Assessment is Key

Don’t wait to start evaluating your clients’ pushing strategies early, ideally in the second trimester. Waiting until 38–39 weeks might be too late to make significant changes. Early assessment allows you and your client to develop awareness, practice, and confidence before labor begins. Even if you only see a client once, a quick assessment (after any necessary pelvic floor release work) can reveal where support is needed.

Understand The Goal: Lengthening, Not Tightening

One of the biggest challenges during labor is “reciprocal pushing”—the tendency to bear down while simultaneously tightening (rather than relaxing) the pelvic floor. This pattern is linked to longer pushing phases and greater risk of severe perineal tears. The real skill is learning to relax and lengthen the pelvic floor while generating downward pressure. Few clients know how to do this automatically, so your guidance is critical!

Assess in Multiple Positions

Not everyone finds pelvic floor lengthening easiest in supine. Explore pushing strategies in various positions:

• Supine: often most challenging, even for pelvic floor therapists!
• Side-lying: improves awareness for many clients.
• Hands-and-knees and tall kneeling: frequently, tall kneeling is where things “click” and clients can most easily find length and release.
• Cycle through positions, and once your client is able to relax and lengthen in one position, help them practice them all—since they can’t predict their labor position.

You can learn how to move your clients through these positions while doing an intravaginal assessment. I show you how to transition through the positions without having to remove your hand which often feels safer or more secure for clients. Learn more in the Holistic Treatment of the Pregnant Body course.

Use Minimal Instruction—Promote Self-Discovery

When exploring pushing strategies, give simple cues initially. For example, while doing intravaginal assessment ask, “Can you push my fingers out?” Observe first—what is their natural response? Do they bear down, do they relax, do they tighten? What do you notice?

Offer verbal cues ONLY if needed to allow clients to discover their innate approach and learn what works best for them keeping in mind that the goal is to relax and lengthen the pelvic floor. You may find that as they try different positions, they naturally find their way for what works best for them and their body without needing your instruction.

Clinical Cues That Help

Everyone is unique, but here are some tried-and-true cues and feedback tools for pushing strategies:

• Compress the lower ribcage on exhale: Squeezing the ribs downward during exhale helps direct pressure to the pelvic floor, not just into the belly.
• Vocalization: Low “didgeridoo” tones encourage pelvic floor relaxation. Experiment with volume, pitch, and style (humming, moaning) to see what best facilitates release for each client.
• Hugging and humming: Pairing a gentle hugging of the belly in and down with vocalization can further promote pelvic release and body awareness.
• Tactile feedback: For clients who cannot undergo internal assessment, have them place a hand around the anus while in side-lying. As they practice lengthening, they can feel the tissue bulge under their hand, enhancing the brain-body connection required for effective lengthening.

Collaborate and Empower (Including Partners!)

Encourage clients to practice their pushing strategies at home and bring partners into the process, if appropriate. Let your clients know that they can connect in with their body to better understand and feel what is going on during labor and birth. Teach partners how to gently offer feedback (such as reminding their partner to feel for tissue bulge or to use the cues that are most effective) to reinforce learning outside clinical sessions. This practice and collaboration will be a tremendous support when it is time for the birth as the body’s ability to lengthen and relax will be more intuitive and automatic.

Advocate for Physiological Pushing—And for Your Clients

Remind clients that labor and delivery staff may default to coached, breath-hold pushing. Equip your clients to advocate for themselves, including the pushing strategies that work for them, so everyone is on the same page: “I’d like to try to try to hum, so I can relax and lengthen when I push. I would like to try pushing like this when the time comes.”

Building your client’s confidence to discuss their preferred pushing strategies is as important as the physical training itself. They can have these conversations with their birth team prior to delivery, add this into a birth “plan” or advocate in the delivery room. Let them know to include their partner in these conversations as well, so their partner can be an advocate for them during labor and delivery as they may be focusing on other things at that time.

Final Thoughts: There Is No One “Right” Cue

Pushing effectively in labor is highly individual. Your creativity, clinical judgment, and willingness to experiment alongside your client are your greatest tools. By starting early, assessing in multiple positions, offering targeted cues, and truly listening, you’ll help more pregnant individuals experience smoother births with less trauma and faster recoveries.

Are there cues or pushing strategies that have worked for you? Share your favorites with the community so we can all support our clients even better!

By focusing on pelvic floor lengthening and individualized push coaching specific to your client’s body and needs, you’re empowering birthing people for stronger, safer births. Let’s keep pushing this conversation forward—together.

About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com