In plain language: Laboring down

Once you’ve reached 10cm dilated, you’ve probably made a hundred decisions already - who’s in the room, how bright the lights are, what your first postpartum meal will be … full dilation sometimes adds one more decision to the pile: push now, or wait a little first.

What is laboring down?

Laboring down, sometimes called “passive descent” or “delayed pushing,” means waiting for a period of time after you’re fully dilated (10cm) before starting to push. The idea is that your contractions do some of the work moving baby down on their own, so you spend less time and energy on active pushing later.

Is laboring down always an option?

Not always. If baby’s already low, you may need only a few pushes no matter what. Many people, especially those who don’t have an epidural (more on that later), feel an urge to push, and that is not something you should ignore.

What does the research say?

Here's the (very) short version: laboring down tends to shorten how long you spend actively pushing, but lengthen your total time in the second stage of labor (from 10cm dilation until birth). In other words, laboring down means you push for less time, but meet your baby later. Choosing laboring down or immediate pushing doesn't seem to impact rates of vaginal birth. Some studies have connected laboring down to higher rates of postpartum hemorrhage, chorioamnionitis (an infection of the uterus), and signs of stress in baby's blood at birth - but the evidence behind those findings is considered low-to-moderate quality, and mostly comes from first-time parents with epidurals. (Source 1, Source 2, and Source 3)

What do professionals recommend?

The American College of Obstetricians & Gynecologists (ACOG), the organization that sets clinical guidelines for OB-GYNs, currently recommends pushing as soon as you reach 10cm, based on evidence that a longer second stage of labor is linked to higher rates of hemorrhage and infection. The Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) states that nurses can support laboring down as long as there is no complication. And the UK’s National Institute for Health and Care Excellence (NICE) recommends offering delaying pushing up to an hour or two, since for some people, waiting to push can lower the likelihood of a cesarean or instrument-assisted delivery (vacuum or forceps).

All three of these groups are working from the same mixed, inconclusive evidence - they just weigh the tradeoff differently. Like with any choice in labor, there are pros and cons to each decision, and ultimately it is your choice about what priorities matter most to you. I’ve seen some people who are ready to start pushing and meet their baby sooner, and others who want to take a pause and get ready both mentally and physically for baby’s birthday party before starting to push.

How does getting an epidural (or not getting one) impact laboring down?

Many people who do not have an epidural feel the urge to push build gradually, and they start pushing when their body tells them to. The laboring down conversation typically comes up for people who don’t feel that urge as clearly.

Does the choice about laboring down depend on my hospital?

In my experience supporting hospital births in Baltimore, yes. I’ve seen units where laboring down is “against policy” and in other units I’ve seen laboring down offered or encouraged. Sometimes it’s framed as evidence-based and sometimes hospital policy. Either way, it’s worth asking your provider directly about hospital policy, their approach, and the approach of other providers in their practice.

How a doula can help

Your doula can help you think through the BRAIN framework - benefits, risks, alternatives, intuition, nothing - with your specific circumstances in mind, and can help you ask your provider what their hospital's typical approach looks like before you're in the moment of deciding.

If a provider moves toward pushing right away and you were hoping to wait (or the reverse), your doula can help you ask about what’s driving the timing and see if there is some wiggle room. And, your doula can remind you that it’s ok to change your mind too!

Explore this further

Evidence Based Birth: Effects of Epidurals on the Second Stage of Labor - covers the research on epidurals and second-stage length, including a section on laboring down and where ACOG and NICE diverge.

Cleveland Clinic: Laboring Down - What It Means & Is It Safe - a plain-language overview of laboring down, including the research on pushing time and second-stage length