To Breathe or Not to Breathe During Second-Stage Labor….

Purple pushing, or directed pushing is a method used to help the mother push out the baby during second stage labor.  This occurs when the mother is told to push while holding her breath as long as she can.  This can lead to the mother damaging blood vessels in her face, hence the name “purple pushing.”  This type of pushing is often used if there has been an epidural or there is a lack of feeling in urge to push.  Purple pushing may be routine for the hospital or caregiver.  According to California Pacific Medical Center (www.cpmc.org), it is not natural to prolong breath-holding and could possibly be damaging to both mother and baby.  CPMC also notes that breath holding is fine to do if it is enhancing the pushing stage.     


Spontaneous pushing occurs when the mother naturally bears down (pushes) for 5-7 seconds at a time, with taking many breaths in between pushes.  According to Pregnancy, Childbirth, and the Newborn (4th Edition): The Complete Guide by authors, Simkin et al 2010 (p. 259), spontaneous pushing provides more oxygen to the baby than purple pushing.  Normally, this type of breathing is used when the labor is normal and there is no epidural.   


With spontaneous pushing, the mother can also try groaning or grunting while exhaling during pushing.  The goal is to envision the baby coming out while relaxing the pelvic floor.  According to American Pregnancy Association (http://www.americanpregnancy.org/labornbirth/patternedbreathing.htm):  It is recommended to slowly release air during the push stage and focus on slow, deep breathing in between contractions to ensure adequate oxygen for baby and mother.  This type of breathing also helps the mother relax between pushes. 


The expectant mother should be aware that epidurals can decrease contraction sensation to the mother, which may result in prolonged labor, purple pushing, and  possibly a Cesarean section (However, controversial evidence exists in timing of epidurals and possible increase in C-sections.  More research needs to be done). 


In the end, the expectant mother needs to do what she feels is best for her and her baby and find a caregiver that is willing to work with her on her birth plan needs.  The more information she gathers for her birthing plan, the more decisive she will feel when it comes time to push.