Self-directed pushing is a steady but gentle pushing effort. Begin your contraction with two cleansing breaths. Take a third breath in and push while slowly exhaling. Take two more cleansing breaths at the end of your contraction.

This slow gentle pushing is especially effective as the head crowns to prevent perineal tearing. As you push, try not to arch your back. Work with your body. Pushing forces should be down and out. Keep your legs wide apart to open your pelvis and give your baby a lot of room to come out. It may be helpful for you to reach down and grab your legs behind the knee and pull back.

Remember, tensing your body, arching your back, lifting your pelvis off the bed, or bringing your knees together, actually works against you by holding your baby in, instead of pushing your baby out.