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• Pay attention to your contraction; your pushing ef- fort should be as long and strong as the power of the contraction dictates.
• Prolonged breath-holding over an extended period of time is physiologically undesirable as it increas- es the chance of maternal exhaustion as well as causing alteration in your blood pressure, which may result in oxygen deprivation in your baby; therefore, it is advisable to do some gentle or ex- hale pushing to decrease exhaustion and minimize blood pressure changes at the beginning of Stage II if you do not experience an urge to push immedi- ately and/or periodically during Stage II when your contractions are not as strong.
• Push while the support person counts (each count is about one second); pushing to a count of around five or six is average; do not hold your breath for more than 10 seconds at a time.
• The “catch breath” should be done quickly and without releasing abdominal pressure; this will prevent your baby from slipping backwards in the vagina.
• Mental visualization of your baby moving down the birth canal and your vagina subsequently opening up may be helpful; when your baby is very low in the birth canal, watching as you push may in- crease the effectiveness of your pushing effort.
• During delivery of the baby’s head, the physician or nurse midwife may ask you to stop pushing; at that time, lie back, and gently blow.

Reminder: Do not push as you practice at home. Instead, practice positions, learn to hold your breath, and think through the pushing process.