Breathing Techniques
There are several breathing techniques that you can use while you are pushing your baby out! Where you are in your pushing timeline will determine which type of technique may be more appropriate. When you are still actively pushing, a closed or open glottis pushing technique may be more appropriate. But, when you are near delivery and your baby is crowning, short, pants and pushes will be more appropriate to ease baby out.
There are some pros and cons to each breathing technique, but ultimately, the best technique is the one that YOU choose to do. Research supports that there are better birth outcomes when it is led by YOU, the person who is giving birth!
Open Glottis Pushing vs. Closed Glottis
The glottis is the throat, so open versus closed is whether or not the throat is closed or open while pushing.
Open glottis pushing is when you are exhaling as you bear down and push. This technique is sometimes referred to as gentle pushing. It may appear less effective since it looks (and feels) less strenuous.
Closed glottis pushing is when you hold your breath as you bear down and push. This technique is more commonly coached in a hospital setting and may be referred to as purple pushing. It may appear to be more effective since it looks like you are exerting yourself so much more. But, appearance does not necessarily mean more effectiveness.
Open glottis pushing is less stressful and can be less fatiguing. But, can be challenging to do if you have a really strong epidural or you don’t feel your pushes. I find that my clients need to either feel their contractions, have a fetal ejection reflex, or have practiced this technique during pregnancy for it to “click” during birth.
Open glottis pushing is usually easiest if you have a fetal ejection reflex, or your body is spontaneously pushing.
I’ve had clients who have epidurals do open glottis pushing and have great births, but they all practiced it beforehand on the toilet.
How can you practice open glottis pushing?
You can practice open glottis pushing while sitting on the toilet when using the restroom, particularly when you are having a bowel movement. When you have a bowel movement, focus on inhaling down into the pelvic floor to feel a lengthening and increase in pressure downward. Then, maintain this downward pressure as you begin to exhale out to breathe your poop out. We want to ensure that the exhale is relaxing, as opposed to building tension.
If you are unsure if you are doing this properly, working with a pelvic floor physical therapist can be helpful! They can walk you through how to push in-person or virtually, and guide you to feel more confident about pushing.
Is Open or Closed Glottis Better??
Neither breathing technique is necessarily better than the other. The best one is the one that you choose. You may find that you even do a combination of both! Think about when you have a bowel movement, you may breathe out for a period of time, then grunt as you hold your breath. The same happens when you push when you are choosing how to breathe!
There are advantages and disadvantages to both techniques that may help you decide which one to choose while pushing. But, neither technique is necessarily faster than the other. Research finds that open and closed glottis can both be just as effective (and just as quick), but you may be encouraged to do one over the other based on how hard it looks like you are working. One study by Araújo et al found that open glottis pushing is associated with a shorter pushing phase and decreased maternal anxiety, but birth outcomes were similar. The study by Barasinski et al found that closed glottis was shorter in duration but not significantly shorter. In my experience with my doula clients, both techniques are just as effective and speedy, but open glottis is usually less fatiguing.
Open glottis is less stressful and fatiguing, and study supports less anxiety-producing which shouldn’t be discounted as a benefit of using this pushing technique! But, if you don’t feel your contractions or pushes, or haven’t ever tried to do open glottis (and the staff is not helpful or familiar with coaching you with open glottis), it can be really confusing to do at the moment. It appears less effective because you look like you are doing less work, although based on research this is not necessarily true.
Closed glottis is a deoxygenated state, so can be more stressful and feel more fatiguing than open glottis. Sometimes closed glottis helps us generate more power, so our push can be a little stronger to help your baby finish a rotation and extension under the pubic arch. Closed glottis is also typically what hospital staff are most familiar with. While it is not necessarily about making the staff comfortable, they may be better able to coach or guide you through your pushing if you use a technique that is familiar to them.
If you feel that you are unsure what to do with pushing, we recommend taking one of our childbirth education courses or attending our every other month pushing webinar, where we break down how to approach pushing with biomechanics. But, another approach is to ask for more coaching while pushing from the staff, your partner, or any other support persons you choose, such as a doula.
Crowning Breathing Technique
The final technique that is important to understand for pushing is how to breathe when your baby is crowning! We want your baby to ease their head out to decrease or alleviate the risk of tearing. When your baby takes their time with their head being born, it allows for the perineal tissues to stretch. It can be helpful to have someone else cue you to slow down, unless you can feel the ring of fire (a burning sensation when baby is crowning due to the intense stretching), or if you can feel the intense pressure.
Crowning breathing techniques involve short pushes, pants, puffs, or any type of breathing that is short in duration that allows you to ease your baby out gently. Sometimes, I’ll cue my client to stick their tongue out or blow out a series of candles on the other side of the room. Your baby is coming, so let’s just ease them out!
There are a few different breathing techniques that are important to know for pushing! We can either do an open or closed glottis pushing technique. Neither is necessarily better than the other, but you should choose the breathing technique and position that works best for you. When your baby is crowning, we want to slow the push down with small pants or puffs, to allow their head to stretch the perineal tissues to hopefully prevent or minimize tearing.
Learn more about pushing techniques in our childbirth education courses or attend our webinar on pushing every other month. We break down the science of birth so that you feel confident about approaching your pregnancy and labor experience!