Women Who Don’t “Push” During Childbirth are 85 Percent Less Likely to Experience Severe Vaginal Tearing

Hospital stops telling women to lie on their backs and “push” during childbirth, reduces instances of severe vaginal tearing from 7% to 1%

Nine in ten women suffer some form of vaginal tearing during childbirth. In severe cases, they are left to suffer from incontinence and lifelong nerve problems.

After a sharp rise in severe perineal tearing in England between 2013 and 2014, the Royal College of Midwives initiated a call to action.

With the support of the Royal College of Obstetricians and Gynecologists, they implemented a trial program at Medway Maritime Hospital in Kent.

By simply not pressuring women to lie on their backs and “push,” the hospital reduced the number of third and fourth-degree perineal tears from 7 percent to 1 percent, an 85 percent reduction.

Dot Smith, the hospital’s head of midwifery, blames the high number of tears on the misconception that women in labor need to “push, push and then push harder.”

“When we saw 22 cases of third-degree tears in a month, we said, ‘this is not good enough,’ she said.

Women in the program were encouraged to birth standing up, squatting or on their knees, which was the norm until the 1950s.

Midwives also encouraged them to breathe naturally through contractions instead of urging them to push.

Instead of pulling the babies out as soon as their heads emerged, the midwives let them come out at their own pace, while supporting their weight to reduce pressure on the perineum.

The program was so successful the results were published in the European Journal Of Obstetrics and Gynecology, and there are plans to implement it nationally.

The simple protocol has already reduced unintentional damage to the bodies of birthing women by 85 percent in some maternity wards.

In an article called To Push or Not to Push, founder of HypnoBirthing Mickey Mongan says trying to “push” a baby into the world is counterproductive:

“Forced pushing creates stress for the birthing mother, which is self defeating in that it closes the sphincters of the vagina ahead of the descending baby.”

Mongan introduced the concept of mother-led breathing, in contrast to staff-directed breathing and pushing over 25 years ago:

She says there is overwhelming evidence today that directed or forced pushing results in:

  • Mother fatigue
  • Increased morbidity for both mother and baby
  • Inefficient uterine surges or contractions
  • Increased risk of hypoxia
  • Fetal heart rate abnormalities
  • Damage to the pelvic floor muscles
  • Ruptures eye and facial blood vessels
  • Tearing of the perenium
  • Increase need for episiotomy





17 responses to “Women Who Don’t “Push” During Childbirth are 85 Percent Less Likely to Experience Severe Vaginal Tearing”

  1. Shianne Shampo Avatar
    Shianne Shampo

    So does this mean no pushing at all, or only push when you feel the natural urge/need??

    1. Melina Avatar

      You will naturally – even through breathing – want to push. What this is implying is not to push on command but rather listen to your body and do so in a position that is conducive to your comfort level – standing, squatting, on your knees. Gravity and nature take control when in these three positions – just breath through the contraction and the baby will begin to drop (which is why there is support, but no pulling). When you PUSH, you’re pushing and then retracting those muscles which pull the baby back in while the doctor is pulling at the same time. This is contradictive to what your body is trying to do when you ‘catch your breathe’ after pushing.

  2. Elsie Avatar

    Baby will push themselves out when ready

    1. Kendra Avatar

      Yes! My fourth child (8 weeks old) pushed himself out! I did not push at all during the whole labor. Which only took about 10 min of “hard labor” where normally I would have been pushing.

  3. miriam hefer Avatar

    When I gave birth in 1977 in the London Hospital, the Indian women were ‘escaping’ to the bathroom to squat in order to give birth.
    Of course they were all brought back to lie on their backs and forced to give birth in this position. Turns out they were far more in tune with the natural birthing process than the then prevailing views.

    1. Ana Avatar

      I did a placement in a hospital in India last year and those women were placed on their backs throughout the labour, had routine shaving and episiotomy for delivery – when I questioned and suggested that they would do better in a more upright/squatting position I was told that indian women would not be able to deliver like this …. interestinghow things have changed in 40 years, the Indian women are being made to deliver like that and we are taking things back to women’s instinct and trusting our bodies in the UK

  4. Zoheir Avatar

    No Push, Babies Find Their Way Out.
    One of the biggest mistakes dealing with the subject of childbirth is that people forget that it is a need of the baby in the womb to get out of it. When it comes to birth, naturally babies find their way out. Without pushing, babies manage to get out using their natural need to be born. They no more need to be a part of their mothers.By pushing women to push their babies, we’re pushing women to get rid of their babies while hurting their bodies, their psychological health and the one of their babies. All women need is to let things work naturally without forcing them.

  5. Margarita Avatar

    I could have saved a lot of tears, all in each different directions.

  6. CKL Avatar

    I tried to share this on my Facebook feed & they removed it because it was against FB community standards, saying it showed nudity!

  7. Rebecca Hughes LM, CPM, RN Avatar

    Mother led pushing has been a part of birthing since the beginning of time. It is only in the more recent past when birthing moved into the hospital setting and out of our homes that that changed. It has remained with most homebirth Midwives.

  8. Debbie Stevens Avatar
    Debbie Stevens

    Thank you so much for this article!!! I am 63 years old, but in my younger years I birthed 5 daughters. I had a 3rd degree laceration and a cervical laceration with my first delivery. The cervical laceration went undetected and unrepaired. It was found with the first checkup with my second pregnancy. This left a weakened cervix for all my pregnancies after my first one. I had to be on some bedrest for them and of course no intercourse during pregnancy as it caused bleeding! I wanted to squat with all my deliveries but was not allowed to this. I remained a Mother Infant Unit RN and Lactation Certified but did not switch to L&D for this reason. I hope your daring change in practices and research will make a profound positive effect in Obstetrics all over the world!

  9. GREG ANDREWS Avatar


  10. Chevy Avatar

    It’s ridiculous how we are forced to push,I was so tired I passed out my heart rate dropped and so did my baby’s heart rate drop we almost didn’t make it all because I was told if I don’t push out that baby now the nurse will leave me alone to die with my child and it’s out of her hands and she left…Today I constantly have Virginal pain,sharp cramps and I easily get with inside because of how I was cut my virgina hasn’t gone back to normal size at all instead it looks ugly and I’m left with this,I could also feel as they were cutting it

  11. Alenka Avatar

    Agree with this. I was walking, relaxing in a bath and kneeling on all four. Then my water broke and I felt urge to push. It did feel like I don’t have to do it, it was just happening. Then actually midwife had to lay me on side as my baby was coming too fast. From water break and the first push he was out in 10min.

  12. Nicola Avatar

    I gave birth to my first child when I was seventeen. I had a wonderful community midwife who came to hospital with me and stayed throughout. I naturally felt a need to curve over my body, on hands and knees it was the only way to cope with the sensations. Gently and with gravites help I gave birth three hours later. I was an incredible experience. When I was at final stage a doctor put his head in the door and said “well I’ve never seen it done like that before…” in no way did I ever feel like lying on my back. My second birth experience was a nightmare, so out of control of what was made to happen.

  13. Carmen Avatar

    Thank you so much for this article! I followed the hypnobirthing method of not pushing, just breathing, for my first child and it worked very well. Was able to deliver naturally without significant tear. I was still on my back, but for my second, will try a more natural position and stick to the breathing, not pushing.

  14. Emma K Avatar
    Emma K

    Does this count/work for mummy’s who get epidural who are unable to mobilise into a squat or all fours positions? I find some mums do not feel an urge to bear down when they have an epidural :/