New Research on Delayed Pushing: What It Means for Labor, Birth & the Pelvic Floor

A study came out in May 2026 in the American Journal of Obstetrics and Gynecology that I have to share because it challenges how we think about delayed pushing and offers important insights for pelvic floor health and birth planning. I believe this is the kind of research that could change how we talk to our clients about laboring.

It’s called “Active Second-Stage Duration Under 15 Minutes in Spontaneous Vaginal Deliveries with Delayed Pushing¹“, done out of Besançon University Hospital in France, looking at over 10,565 births between 2018 and 2024. If you work with pregnant or postpartum clients, I really want you to know this data exists, because it gives us something concrete to hand our clients when they’re building their birth plans.

Wait, what is delayed pushing again?

So let’s back up. Delayed pushing, sometimes called laboring down, occurs during the second stage of labor and means waiting to begin active pushing after the cervix is fully dilated, allowing the baby to descend before the mother actively pushes. With immediate pushing, active pushing begins soon after complete dilation.

The second stage of labor is everything from full dilation to birth, and has two parts: a passive phase, where baby is just descending on their own with no active pushing happening (i.e. delayed pushing), and an active phase, where mom is actually pushing.

In the US, ACOG guidelines allow at least three hours of pushing for first-time moms and two hours for moms who’ve given birth before, with room to go longer if there’s an epidural and baby is still moving down. But in France, they do things differently. They wait to have mom push until she actually feels the urge and baby’s head has come down low, prioritizing that passive descent phase first.

This study wanted to figure out exactly how long active pushing actually takes when you manage labor this way, and what factors change that duration, things like parity, fetal position, epidural use, and whether labor was induced.

Who was in the study

They looked back at 10,565 spontaneous vaginal deliveries. To be included, moms had to be over 37 weeks, pregnant with one baby, head-down, and end up with a spontaneous vaginal delivery, epidural or not, induced or not. They excluded preterm babies, stillbirths, breech or transverse babies, twins, C-sections, and any assisted deliveries like forceps or vacuum.

Average maternal age was 30.6 years, average gestational age at delivery was 39 weeks, and 36% of these moms were having their first baby. And get this, 98% delivered on their backs, which tells you something about standard practice at this hospital.

The number that blew me away: 8.8 minutes

Here’s the part that gets me excited. Even with a delayed pushing policy that allowed up to three hours before active pushing started, the average active pushing time was only 8.8 minutes, with a median of just 6 minutes, and a range of 0 to 64 minutes. So even though moms were given all this time to just let baby descend, once they actually started pushing for real, most of them delivered incredibly fast.

Here’s how that pushing time broke down by different factors:

Factor	Group	Mean Pushing Duration
Passive second-stage length	Under 1 hour	7.5 minutes
Passive second-stage length	1–2 hours	10.9 minutes
Passive second-stage length	2–3 hours	14.2 minutes
Parity	First baby	14.0 minutes
Parity	Had babies before	5.9 minutes
Fetal head position	Anterior	9.0 minutes
Fetal head position	Posterior/transverse	10.5 minutes
Fetal station at pushing onset	Outlet (lowest)	6.0 minutes
Fetal station at pushing onset	Higher stations	8.7–9.8 minutes
Epidural use	With epidural	9.3 minutes
Epidural use	Without epidural	6.6 minutes
Labor onset	Induced	9.6 minutes
Labor onset	Spontaneous	8.7 minutes

Not surprising to any of us, but the biggest predictors of shorter pushing were having given birth before and baby being in a good anterior position. And moms with epidurals had way longer passive phases overall, about 90 minutes compared to just 12 minutes without one, which makes sense since epidurals dull that urge to push.

And outcomes were great, too

Here’s the thing, this approach didn’t come at a cost to moms or babies. Postpartum hemorrhage happened in only 5.1% of deliveries, and severe perineal trauma in just 0.5%. Babies did great too, 99.2% had Apgar scores above 7 at five minutes, and 73.4% had reassuring cord pH levels.

Does active pushing time matter more than total labor time?

This is the piece I really want you to sit with. The researchers point out that a lot of what we’ve blamed on a “prolonged second stage,” things like maternal exhaustion, hemorrhage, pelvic floor trauma, might actually have more to do with how long someone is actively pushing, not how long the whole second stage lasts.

They back this up by citing Pythagore VI, a huge French study with over 146,000 women, which found a clear linear relationship: every additional 10 minutes of active pushing significantly raised the odds of severe postpartum hemorrhage, even after controlling for parity, oxytocin, and instrumental delivery. So it’s not the waiting around that’s the problem, it’s the actual pushing effort that adds risk. That’s such an important distinction to be making with our clients and their providers.

Does Delayed Pushing Protect the Pelvic Floor?

Okay, and this is the part that really speaks to me as a pelvic floor PT. There’s biomechanical modeling research showing that damage to the levator ani, specifically the pubovisceral muscle, builds up based on the frequency and duration of individual pushes, not the total time of the second stage. The researchers actually concluded that active pushing duration is a better predictor of muscle injury than total second-stage length, which is exactly what many pelvic floor PTs have suspected all along.

They describe this as a “low-cycle fatigue” mechanism, meaning repeated forceful pushing causes cumulative microdamage at the muscle’s attachment point, kind of like how repetitive strain injures a tendon over time rather than one big tear happening all at once. And there’s clinical data backing this up too. A 2026 study on primiparous moms delivering bigger babies found that second stages lasting three or more hours were tied to weaker pelvic floor muscle strength, more levator hiatus enlargement, and higher rates of prolapse on ultrasound shortly after birth.

Now here’s an interesting wrinkle. A secondary analysis of the Cahill immediate-versus-delayed pushing trial actually looked at levator ani injury directly with imaging and found no difference between the immediate and delayed pushing groups. So when pushing starts doesn’t seem to change injury risk on its own. Honestly, I think this strengthens our case even more, it’s not about delaying for the sake of delaying, it’s about minimizing how much active pushing actually happens once it starts. That gives us a real, tissue-level reason to bring this information up in conversations with clients and providers, beyond just the hemorrhage and tearing stats.

But let’s be fair, not every study agrees

Now I want to be fair here, because not every study agrees, and I think it’s important we know both sides. A 2018 US trial published in JAMA, with 2,414 first-time moms with epidurals, found no difference in vaginal delivery rates between immediate and delayed pushing, but the delayed group had a longer total second stage, 134.2 minutes versus 102.4 minutes, along with higher rates of chorioamnionitis and postpartum hemorrhage. A Cochrane review found similarly mixed, low-quality evidence, with delayed pushing sometimes lengthening the total second stage without clearly improving outcomes.

That said, the newer NICE guidelines out of the UK do endorse delayed pushing for women with epidurals specifically, citing reduced instrumental delivery rates without added risk to babies, which lines up with what the Besançon study found. So what this tells me is that outcomes probably depend a lot on the specific protocol, how pushing is coached, and the population being studied, not that delayed pushing is simply better or worse across the board.

Study	Design	Key Finding
Montfort et al., AJOG 20261 (this study)	Retrospective cohort, France, n=10,565	Active pushing under delayed-pushing policy averaged 8.8 min; low PPH (5.1%) and severe trauma (0.5%) rates
Cahill et al., JAMA 20182	RCT, US, n=2,414 nulliparous with epidural	No difference in vaginal delivery rate; delayed pushing had longer second stage and higher PPH/chorioamnionitis rates
Cochrane systematic review3	Meta-analysis of multiple RCTs	Delayed pushing reduced active pushing time by ~19 minutes but increased total second-stage length by ~56 minutes with epidurals; evidence rated very low quality
PASST RCT, 20234	RCT, France	Intensive pushing technique shortened active pushing (26 vs 32 min) without increasing perineal trauma

What Can You Do With The Delayed Pushing Study?

So here’s what we can take away from all this. The Besancon study gives us evidence-based language to bring into conversations with our clients, and honestly, into their birth plans too. Letting baby take their time descending before active pushing starts, letting that happen physiologically, may reduce how much active pushing work actually has to happen, and that could mean less perineal edema, less tearing, and lower hemorrhage risk, especially for first-time moms or babies who aren’t in the best position yet.

But I also want us to hold this with some nuance. The US trials and the Cochrane review remind us that not every setting will see the same results, so I’m not saying we throw a blanket policy change at every hospital overnight. What I am saying is that this is open access, so print it out, share it with your clients, and encourage them to bring it into conversations with their providers. Because when moms understand there’s a physiologic option and they know how to advocate for it, that’s how we start to see real change at the ground level.

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

Citations and References

1. https://www.ajog.org/article/S0002-9378(25)00937-8/fulltext ↩︎
2. https://jamanetwork.com/journals/jama/fullarticle/2706136 ↩︎
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC6464699/ ↩︎
4. https://www.sciencedirect.com/science/article/abs/pii/S0002937823005069 ↩︎