When the "transition" stage of labor ends and the rhythm of the contractions slow again, the caregivers wait with the woman until she feels an urge to push. Sometimes there is still a little bit of cervix, but it's going to go away with the beginning pushes. sometimes the cervix is out of the way for a little while before she get any urge.

A big part of finding out how her body will push best is discovered by changing positions and moving around until the woman finds the position that works best for her.

She usually will hold her breath only briefly, if at all, so her throat is open.

She usually will make low-pitched noises, like a grunt or sigh, so her mouth and jaw are relaxed and open.

Contractions vary in intensity, so she will feel a need to push gently or not at all with some, while others will "carry her away" into strong bearing down efforts.

She usually will feel the need to bear down only after the strength of the contractions has built to its peak and she cannot resist the urge to add her effort to the work of the muscles.

She usually will give four to six short bearing down effort per contraction with good breaths between pushes.

The emphasis in this part of labor is on letting go and going with the urge to push with short efforts. The effect is that of the woman "opening to let the baby out".

The sense that the uterus is working hard and the woman is going along with the labor, letting go and adding bearing down efforts, leads to a more relaxed atmosphere and a more relaxed body, including the perineum. When the vaginal opening is relaxed, the body does not need to work as hard because it is bringing the baby down onto muscles and skin which are more yielding.

It is each woman's own body which is leading the way, so she pays attention to her own sensations and follows the lead of her uterus.

Our culture has taught us to "plan" for birth, to "practice breathing" so we will be "ready" for labor. But birth is not really a mental even. It is a physical one. Perhaps the most important preparation is not to try to "learn" what to "do". It may be more valuable to develop confidence that your body will tell you - that you will know - how to let go and add your effort to the work of the contractions at the right time.

Birth is not a mental even, and it isn't one that we have complete control over. A lot of built-in reflex activity is involved, processes which will unfold without conscious effort, like yawning and stretching when you are tired. Just think for a minute how hard it is to keep from yawning and stretching when you have the urge to to do so - and how good it feels to do it when you can. Birthing is a complex and powerful process that your body knows will how to perform. You will want support and encouragement, but there is no need to worry that you won't know how to give birth.

When the time comes, you and your caregivers will work together to give you and your baby safe passage. It is good to have a birth plan which will help you tune in to your body and push on your own. It is also good to remember that you will not be alone. Your caregivers will be helping you the whole time. Let them know what you need.

Research has already demonstrated several benefits to spontaneous bearing down efforts.