What Is Purple Pushing? And Do You Have to Push That Way?
For many of us, when we think of birth, we imagine a scene similar to what we’ve seen on TV: a woman lying flat on her back, screaming while a doctor urgently tells her to push. While television often exaggerates the drama of birth, some parts of this image do reflect what commonly happens in hospital settings.
In many hospitals, the birthing person is asked to lie on their back with their legs in stirrups. A nurse or provider may then “coach” them on how to push. This usually involves holding your breath while pushing for a count of ten, pulling your legs back, and pushing as hard as possible. This sequence is repeated several times during each contraction.
This method of pushing is often referred to as “purple pushing.”
What Is Purple Pushing?
Purple pushing is a directed pushing technique used during the second stage of labor (the pushing phase). It involves holding your breath and bearing down for about 10 seconds while pushing.
The name “purple pushing” comes from the fact that holding your breath and pushing so forcefully can cause your face to turn red or purple.
While this method has become very common in hospital births, it’s important to understand that it isn’t the only way to push—and it may not always be the most beneficial approach.
Why Can Purple Pushing Be Problematic?
When you hold your breath while pushing, oxygen flow to both you and your baby is temporarily reduced. When this happens repeatedly during contractions, it can sometimes lead to signs of stress for the baby.
If a baby begins to show signs of distress during labor, providers may feel the need to intervene. This could include:
Assisted delivery using forceps or a vacuum
Additional medical interventions
In some cases, an emergency C-section
While these interventions can absolutely be necessary in certain situations, reducing unnecessary stress during labor may help decrease the likelihood of needing them.
You Don’t Have to Push This Way—Even With an Epidural
A common misconception is that if you receive an epidural, you must push using the purple pushing technique. However, this isn’t necessarily true.
When an epidural is working well, you should still be able to feel pressure from your baby’s head as it moves down the birth canal. This pressure can naturally signal when your body is ready to push.
Instead of holding your breath for long periods, many people find that following their body’s natural urges leads to shorter pushes or small grunts during contractions. You may briefly hold your breath during these pushes, but there are also natural pauses where you breathe normally—allowing oxygen to continue flowing to you and your baby.
This is often called physiological or instinctive pushing.
You Don’t Have to Push on Your Back
Another myth is that if you have an epidural, you must push while lying flat on your back. In reality, many positions are still possible and may even help labor progress more effectively.
Some alternatives include:
Side-lying position with a partner or nurse supporting your leg
Semi-sitting or upright positions
The “throne” position, where the hospital bed is raised fully so you are sitting upright while pushing
Upright or side-lying positions can help work with gravity and may feel more comfortable for many birthing people.
You Still Have Options in Birth
Giving birth is incredibly hard work, and it can also be painful. Choosing to get an epidural is a completely valid decision, and no one should feel judged for making the choice that feels right for them.
But it’s important to remember that having an epidural does not mean you lose all of your options.
Even if a doctor or midwife recommends a certain position or pushing method, you still have the right to ask questions, request alternatives, and make informed choices about your body and your birth whenever possible.
Why Birth Support Matters
Advocating for yourself during labor can be challenging—especially when you’re focused on bringing your baby into the world. This is where a support team can make a huge difference.
A partner, family member, or doula can help communicate your preferences and support the birth plan you created ahead of time.
Creating a birth plan before labor begins helps ensure that everyone on your support team understands your wishes and how best to support you if challenges arise.
Birth doesn’t always go exactly according to plan—but having knowledge, support, and options can help you feel more confident and empowered throughout the experience.
