By The PPH Foundation

Knowing the right time to push during labour is one of the most important moments for a mother, her baby, and the healthcare team supporting her. It marks the transition into the second stage of labour, the phase when the cervix is fully dilated and the body naturally prepares for birth. But for many women, this moment is confusing, frightening, or rushed, and when the process is not well guided, the risk of complications including postpartum haemorrhage, PPH, increases significantly.

Midwives and skilled birth attendants note that most women feel an overwhelming, instinctive urge to push once the cervix reaches full dilation. The timing is not the same for every woman, and clinical guidelines indicate that if no pushing urge is present one hour after full dilation, a reassessment is required. When pushing begins too early, before full dilation or before the baby has descended fully, the cervix may swell or the labour may stall. This often results in interventions and prolonged labour. When pushing is delayed too long, maternal exhaustion and fetal distress may occur.

Both situations directly influence the risk of PPH. Evidence shows that the longer the second stage of labour continues, the higher the chance of excessive bleeding. Maternal exhaustion, slow labour progression, and the need for interventions all increase the likelihood that the uterus will fail to contract properly after birth, a condition known as uterine atony. This is the leading cause of PPH. Research also shows that prolonged first-stage labour significantly increases the likelihood of PPH because the uterus becomes fatigued and less able to contract effectively after delivery.

Recognising the right time to push is therefore more than a labour milestone, it is a critical safety point. Women need continuous support, calm communication, and skilled guidance from their healthcare providers. With well-timed pushing, shorter labour duration, and proper monitoring, the risk of postpartum haemorrhage can be reduced dramatically.

Through its advocacy and training programmes, the PPH Foundation emphasises the importance of safe, well-guided labour practices. Ending PPH requires not only emergency readiness but also supporting mothers through each labour stage, from the first contraction to the last push.

Photo by Saúl Sigüenza: https://www.pexels.com/photo/birth-of-a-baby-28099427/

Sources
Cleveland Clinic, Stages of Labour
World Health Organization, Second-Stage Labour Guidance
American Journal of Obstetrics & Gynecology, Duration of Pushing and Risk of PPH
Scientific Reports, Prolonged Labour and Postpartum Haemorrhage