Push Until You're Purple

Think about the last birth scene you saw on TV. Was the woman screaming and yelling like a maniac? Was everyone around her frantic and flustered?

With a few exceptions, I just described about every birth scene on television ever. So think back for a moment. What is the one thing that everybody always yells at the woman in your typical birth scene?


Do you need to have people yelling at you to hold your breath and count to 10 before you stop pushing? Is this beneficial or is it yet another birth stereotype?

Let's take a look!

The type of pushing I described above has a few names. It is known as directed pushing, closed glottis pushing, the valsalva maneuver or, my favorite, purple pushing.The frightening reality is that a mom can actually turn a light shade of purple or burst blood vessels in her eyes when she pushes like this.

Directed pushing is when you are instructed to push when you reach 10 centimeters dilation, regardless of whether you have an urge to bear down or not. You will be told to take a deep breath as a contraction begins and then hold your breath and push as long as you can (you're often encouraged to do this for a full 10 seconds at a time). This is usually done while your doctor, nurse and spouse loudly tell you to "push harder!"

So how did this practice originate? In the 1950s, medical literature was published that reported a relationship between prolonged second-stage labor and maternal-neonatal morbidity. At the time, it was thought that this forceful, directed pushing got the baby out faster.

Well I’ve got a newsflash for you: Studies show that purple pushing only shaves 2.5% (on average) off of the second stage.

Yes. You read that right: 2.5%. In a ten hour active labor phase, that’s 15 minutes.

And that’s it.

Second newsflash: That 1950’s medical literature was wrong. There is no connection between a prolonged second stage of labor and maternal-neonatal morbidity. Not only was it wrong but closed glottis pushing can actually have a number of serious adverse effects. In fact, research does not support the routine use of directed pushing, and some researchers suggest it is harmful.

So if directed pushing doesn’t significantly shorten the second stage of labor, why is it used so frequently? The long and the short answer? There really isn’t a good reason. But here is why purple pushing should be discarded as a routine practice.

  1. It can deprive your baby of sufficient oxygen.

  2. It can damage your perineal floor.

  3. It can lead to larger tears.

  4. It can exhaust you.

And the benefits of purple pushing? You may spend about 2% less time in the second stage of labor. In some cases, it may help the mother who has an epidural to push effectively but this is the exception, not the norm. Another time when directed pushing may be helpful is if a mother is struggling to push effectively, whether or not she has received pain medications - sometimes that's what a mom needs to get her baby out. As with all techniques, there is a time and a place for it but it should not be the default. 

Like other outdated medical thought, purple pushing has become ingrained in our birthing culture and women are the ones who pay its price. So next time you see a birth scene on tv, remember: that’s not how pushing is supposed to go. Rather, it’s part of old school medical thought that should be discarded as routine practice.