Written by

Gina Conley, MS

December 11, 2025

Creating Space in the Pelvic Outlet: Tips for Pushing

Birth Preparation, Pregnancy, Pushing

When most people think about pushing during labor, they picture one cue: knees in, ankles out. And while that internal rotation does help create space in the pelvic outlet, it’s only one small piece of what actually supports effective pushing.

In reality, pushing is a whole-body, soft-tissue, pressure-management process—not just a hip position. In this blog, we’re breaking down the mechanics that matter most so you can prepare your body for a smoother, more intuitive pushing experience.

I’m Gina, perinatal fitness trainer and birth doula, and alongside Certified Nurse Midwife Roxanne, we’re diving into:

How pelvic outlet space is created
Why soft tissue matters more than you might think
How rib cage positioning impacts pushing power
Why asymmetrical pushing positions can help baby rotate
What birth pros look for when progress stalls
And what you can do prenatally to prepare

Let’s get into it.

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Pelvic Outlet Space: More Than Just Bones

If you follow birth content online, you’ve probably heard the cue: knees in, ankles out to help open the pelvic outlet. This movement creates internal rotation of the hips, widening the space between the ischial tuberosities (your sitz bones).

That is helpful.
But the pelvic outlet is mostly soft tissue, not bone.

While earlier phases of labor rely heavily on creating space through the bony inlet and mid pelvis, the outlet depends on tissues that must stretch, yield, and release—which means mobility is only part of the equation.

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A post shared by Gina, MS, & Roxanne, CNM (@mamastefit)

Hormones Help (But You Still Need to Work With Your Body)

During pregnancy and labor, your body is awash in hormones that affect pelvic outlet tissues:

Estrogen → increases blood flow and flexibility
Relaxin → supports ligament and joint laxity
Progesterone → promotes smooth muscle relaxation
Prostaglandins → soften pelvic tissues during labor

These create a more “malleable” pelvic floor, but learning to consciously release that tissue is still key for pushing.

Why Your Rib Cage Matters for Pushing Power

This is the part many birthing people—and even some professionals—have never been taught.

Your rib cage position directly influences your pelvis, which means it also affects:

your ability to open the pelvic outlet
your ability to create downward pressure for pushing

Rib Cage and Pelvis: A Connected Chain

Your ribs anchor your spine, and your spine anchors your pelvis.
When you arch your back:

your pelvis tips forward (anterior tilt)
internal rotation becomes harder
pushing pressure goes forward, not down

When you round your back slightly:

your pelvis tucks (posterior tilt)
internal rotation becomes easier
your diaphragm aligns directly over the pelvic outlet

This is the position that lets you create strong, efficient downward pressure, because pushing is truly a pressure-management activity.

Your diaphragm moves downward when you inhale, stacking pressure over the uterus and helping guide baby into and through the outlet.

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A post shared by Gina, MS, & Roxanne, CNM (@mamastefit)

Most Babies Are Not in the Outlet When Pushing Starts

As midwife Roxanne explains, we often assume pushing happens only once baby is in the pelvic outlet—but most babies are still in the mid pelvis when pushing begins.

This means:

they still need room to rotate
symmetrical positions (like both knees in) may limit that rotation
asymmetry often helps baby navigate the last portion of the pelvis

This is why relying solely on knees in, ankles out can sometimes slow progress.

Asymmetrical Pushing Positions That Actually Help

Asymmetry creates space on one side of the pelvis at a time—often exactly what baby needs to rotate beneath the pubic bone.

Here are some ways to add asymmetry:

1. Hands-and-Knees Shift

Shift weight slightly to the left
Allow the right leg to externally rotate
Use a pillow, rolled towel, or yoga block under the left knee

This lifts the left side of the mid pelvis—where most babies rotate—helping them dip under the pubic bone.

2. Asymmetrical Semi-Reclining or Side-Lying

Pull the left leg toward the body (internal rotation)
Keep the right leg extended or externally rotated
Use pillows for support

This position lifts the left pubic half, creating diagonal space for baby to rotate and descend.

Many birthing people intuitively gravitate toward these asymmetries—especially when on hands and knees.

Soft Tissue: The Hidden Factor in Pushing Difficulty

The pelvic outlet is primarily:

pelvic floor muscles
ligaments
connective tissue
the perineum

Not the bones.

This means tension or asymmetry in the pelvic floor can block descent, even if the pelvis itself is positioned perfectly.

The Right Anterior Pelvic Floor: A Common Culprit

Birth providers frequently notice that the right anterior portion of the pelvic floor can feel:

thick
dense
unyielding
like a “brick wall,” as Roxanne describes

If this tissue cannot release, it prevents the right posterior pelvis from tightening, which in turn prevents the left anterior pelvis from lifting—making it harder for baby to rotate under the pubic bone.

How Providers Can Help

With consent, a provider may:

Apply gentle pressure to the tight area
Help the tissue release
Suggest positions emphasizing external rotation on the right leg

This often creates immediate improvement in descent and rotation.

Don’t Wait Until Labor—Train Your Soft Tissue Now

The incredible part?
You don’t have to wait until labor to work on this.

There is SO much you can do during pregnancy to improve:

pelvic floor yield
tissue mobility
asymmetry awareness
rib cage and pelvic alignment
pressure mechanics

These tools make pushing more intuitive and effective once the time comes.

Want More Support?

We offer several resources to help you prepare:

Final Thoughts

Pushing isn’t just about positioning your legs.
It’s about:

soft tissue that can yield
a pelvis that can move
a baby that can rotate
and a rib cage that aligns pressure downward

By understanding the whole-body mechanics—not just one cue—you can create more space, push more effectively, and feel more empowered during birth.