When you're dilated to 10 centimeters, it's time for the pushing to begin. There are two basic pushing techniques, called Valsalva Pushing and Self-Directed Pushing. These pushing techniques can be used in a variety of different positions.

Valsalva pushing is a steady pushing effort through each contraction. You begin your contraction with 1 or 2 cleansing breaths, then you take a third breath and hold it in. As you hold your breath, push down with the contraction. You should take a quick breath between pushes so that your baby doesn’t slide back too far between pushes. Some women find it helpful for their partner to count to ten with each push to aid concentration. This count should last about 6 seconds. Don't hold your breath for too long. Your goal should be 3 pushes with each contraction, and you should take a deep breath between each push. Take 2 more cleansing breaths at the end of the contraction.

Self-directed pushing is a steady but gentle pushing effort. Begin your contraction with 2 cleansing breaths. Take a third breath in and push while slowly exhaling the air. Exhaling can be accompanied by soft moaning or groaning sounds. Take 2 more cleansing breaths at the end of your contraction. This slow gentle pushing is especially effective as the head crowns to prevent perineal tearing. As you push, curl up around your baby in a "C" shape. Try not to arch your back. Work with your body. Pushing forces should be down and out. Keep your legs wide apart to open your pelvis and give your baby lots of room to come out. It may be helpful for you to reach down and grab your legs behind the knee and pull back. Remember, tensing your body, arching your back, lifting your pelvis off the bed, or bringing your knees together, actually works against you by holding your baby in instead of pushing your baby out.

Using the "semi-sitting" position, in a birthing chair or bed, allows you to rest between contractions. Be sure not to lay flat while you're pushing because this works against gravity. The "semi-sitting" position is probably the most frequently used pushing position.

The standing position is a great alternative if you get tired of sitting. This position also makes the most of gravity. Stand up supported by your coach or by leaning against the wall, bed, or back of a stable chair. Continue your breathing and pushing techniques.

The squatting position can be used easily by lowering the bottom of the birthing bed, or a squatting bar may be attached to your bed. This allows you to hold the bar just like the handles of a motorcycle. As your contraction starts, lean forward with your feet on the lowered portion of the bed. Lean into a squat position, supported under your arms by your coach and another member of your health care team. Sit back and rest on the upper part of the bed between contractions. This position opens the pelvis to its maximum dimensions and uses the help of gravity.

To use the "hands and knees" position, get on your hands and knees on the bed. Curl down around your baby as the contraction starts and bear down. This position may be helpful for rotating your baby if he is in a posterior position, or “sunny side up”.

While lying on your left side, your coach supports your upper, or right, leg. While this position is not best for expansion of your pelvis, it does provide the most oxygen for your baby. The "left-lateral" position is often used when a baby does not tolerate pushing in other positions.