Laboring Down

What is laboring down?

Laboring down is a period of not actively pushing when you are fully dilated. Most pregnant people begin pushing once their cervix dilates (widens) to about 10 centimeters. This is the beginning of the second stage of labor, when your baby starts moving out of your birth canal.

But some people may not feel the urge to push for one to two hours after the second stage begins. They may wait until the baby crowns (the baby’s head starts to emerge from the birth canal) or they feel an overwhelming urge to push. By laboring down (also called “delayed pushing” or “passive descent”) they’re letting their bodies do more of the work. The uterine contractions, combined with gravity, naturally bring the baby further down into the birth canal.

Can you labor down with an epidural?

It’s possible to labor down with an epidural. However, if you have a strong epidural and are numb, you may not feel the natural urge to push. Your healthcare provider or birth partner will need to help you know when it’s time to start pushing.

If you don’t have an epidural, you’ll feel a natural urge to push. If you choose to labor down, you wait until this urge becomes uncontrollable.

As of 2019, the American College of Obstetricians and Gynecologists (ACOG) no longer recommends laboring down for people who’ve had an epidural. They recommend that people should begin pushing once the second stage of labor begins, even if they don’t feel a natural urge to push.

How common is laboring down?

Laboring down is a fairly common practice, especially in people who haven’t previously given birth. For first-time parents, it’s hard to predict how long labor and delivery will last. Laboring down may conserve energy if labor is lengthy.

What is the difference between delayed pushing and immediate pushing?

Delayed pushing means resisting the urge to push for the first part of the second stage of labor. It can also mean only pushing very lightly. Immediate pushing is when a person starts pushing as soon as the cervix reaches 10 centimeters. It usually takes the form of directed pushing. This means your healthcare provider will coach how to push during each contraction.

What are the effects of laboring down?

Studies show that laboring down for one to two hours extends the length of the second stage of labor by about an hour. But it also cuts down the total time that a person has to push before delivery by about 20 minutes.

Some healthcare providers also believe that laboring down:

• Helps people conserve energy for pushing.
• Improves the chances of a vaginal delivery.
• Reduces the risks of a cesarean birth (c-section) or complications during labor.

Is laboring down safe?

Recent studies show that there’s no evidence that delayed pushing has benefits over immediate pushing. In fact, some studies show slight increases in the following complications with delayed pushing:

• Chorioamnionitis (a bacterial infection in the sac and fluid around the fetus).
• Postpartum hemorrhage (heavy bleeding after giving birth).
• Neonatal acidemia (a newborn’s blood is too acidic).

What can I do to decide if laboring down is the right choice for me?

Work with your healthcare provider, birthing partner and midwife to make a clear birth plan. Learn the risks and benefits of laboring down for your particular situation before making a decision.

A note from Cleveland Clinic

Laboring down is the practice of not pushing for one to two hours immediately after the second stage of labor begins. It may help your baby descend into the birth canal more naturally and reduce the overall time you have to push. But studies suggest delayed pushing could pose some health risks to you and your baby. Discuss the risks and benefits with your healthcare provider when you make your birth plan.