Laboring Down: Do It or Skip It?
(written by Jessica Dufault, PT, DPT)
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POV: You’ve reached 10 cm (whew!) and the hospital birth team tells you that it’s time to push!
But you learned that you have options with something called laboring down. And you can weigh the pros and cons (because you’ve read this article) and make the right decision for your birth.
But it’s all a bit confusing, to be honest. The American College of Obstetricians and Gynecologists (ACOG) were once all for it. Until they weren’t. But some providers (especially midwives and some OBGyns) still encourage it. And I strongly encourage you to discuss with your birth team before your birth to ensure you are getting the birth you desire.
First, what is it?
Laboring down is the time spent (sometimes even 1-2 hours) between reaching 10 cm and starting to push. It’s the space to allow the uterus to continue to do its job, pushing the baby further down into the pelvis and waiting until you feel the desire to push, or until someone sees baby’s head!
“Where is baby in my pelvis?” can be a helpful question to determine the best course of action for you! You can get this information from station (-5 to +5), which tells you where your baby’s head is in relation to your pelvis. Negative stations = baby is higher in your pelvis. Positive stations = baby is lower in your pelvis. If baby is +2 or higher (+1, 0, -1, etc), then you might consider laboring down so you don’t have a longer distance and extended time spent actively pushing.
Why might this be helpful?
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When you spend less than 1 hour actively pushing, you significantly reduce your risks of perineal tears, pelvic organ prolapse, hemorrhoids and even postpartum incontinence. (1, 2) Laboring down can reduce your push time by 50%. (3) It’s my full time job as a pelvic PT to help you reduce your risks for these kinds of birth injuries!
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It conserves your energy. (1)
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It may reduce your risk for interventions (like cesarean birth) in hospitals with high cesarean rates.
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It may reduce your risk for episiotomy and instrument assisted birth. (4)
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Utilizes your body’s natural processes, like the fetal ejection reflex.
What are the risks with laboring down?
Until 2018, this was a common practice in birth, no matter your provider or if you had an epidural or were unmedicated. But here is what has changed.
  Without an epidural
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There are no major risks to laboring down! You should be able to wait to push until there’s an urge to do so (unless the urge happens before you are fully dilated).
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There are some risks associated with a longer second stage of labor, meaning the time spent fully dilated (but does not include active pushing time). However, those risks are less when you are moving and have the option to birth in whatever position feels right.
  With an epidural
New research in 2018 (5) indicates there may be some risks associated with delayed pushing:
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Increased risks for infection (chorioamnionitis - bacterial infection in the sac). Because of this, you might consider limiting or even skipping cervical checks to reduce your risks!
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Increased risks for postpartum hemorrhage
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Neonatal acidemia (newborn’s blood is too acidic)
Now what?
If you want to labor down with or without an epidural and you have a healthy, low-risk pregnancy, this might be an option. With all things, there are pros and cons and you will need to talk with your team ahead of time. “Hospital policy” and certain providers might dictate what you can/can’t do…however, you have the right to make choices based on informed consent.
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