To push or not to push?

Women in the second stage of labour instinctively bear down for short periods of four to six seconds. Most of these spontaneous bearing down efforts are accompanied by the release of air, with several breaths being taken between each effort. Conventional pushing techniques with sustained breath holding compromise fetal well being by reducing maternal arterial pressure and the oxygenation of maternal blood. Adequate progress may be made in labour, with the delivery of a healthy baby, when the management encourages spontaneous maternal efforts.