During childbirth, one of the most important aspects of the pushing stage is how a mother uses her breath and muscles to help the baby descend through the birth canal. Two common techniques open glottis pushing and closed glottis pushing are often discussed in labor preparation classes and among healthcare providers. Understanding the difference between open vs closed glottis pushing can help expectant mothers make informed choices about what might work best for their bodies and their birthing experience.
Understanding the Glottis and Its Role in Pushing
The glottis is part of the larynx, located in the throat, and it controls airflow in and out of the lungs. During pushing in labor, how a woman uses her glottis either keeping it open or closed can influence the amount of pressure exerted on the uterus and the baby. This, in turn, affects oxygen flow, maternal fatigue, and overall comfort during delivery.
What Is Closed Glottis Pushing?
Closed glottis pushing, sometimes referred to as Valsalva pushing, is a technique often used in hospital settings. It involves taking a deep breath, holding it, and pushing down forcefully while the mouth and throat are closed. This type of pushing typically occurs when a care provider instructs the mother to take a deep breath and push for ten seconds during a contraction.
- MechanicsThe closed glottis increases intra-abdominal pressure, which helps push the baby down the birth canal.
- DurationUsually involves holding the breath for 8 10 seconds and repeating the push multiple times per contraction.
- EnvironmentCommon in managed hospital births, especially when continuous monitoring or epidural use is involved.
This technique may feel similar to bearing down during a bowel movement. It allows healthcare providers to coordinate pushing efforts and may seem more efficient when active guidance is preferred.
Advantages of Closed Glottis Pushing
- May speed up the pushing stage in some cases.
- Allows for synchronized effort between mother and medical staff.
- Can be easier for mothers with epidurals who may not feel strong natural urges to push.
Disadvantages of Closed Glottis Pushing
- Reduces oxygen supply to both mother and baby during long breath-holds.
- Can increase the risk of fatigue, perineal tears, or pelvic floor strain.
- May lead to higher blood pressure and greater physical stress.
- Can feel forced or unnatural, especially if the body isn’t ready to push.
Because closed glottis pushing relies heavily on breath-holding, some women may feel lightheaded or overwhelmed after several contractions. It can be effective but may not be the most comfortable or physiological approach for everyone.
What Is Open Glottis Pushing?
Open glottis pushing is a more spontaneous, instinctive technique that allows the woman to exhale while bearing down. Instead of holding the breath, the mother keeps her throat and mouth open, making a deep exhale or low moaning sound as she pushes. This type of pushing is often encouraged in natural or unmedicated births where the mother can follow her body’s cues.
- MechanicsThe glottis stays open, allowing air to flow out as pressure builds in the abdomen.
- DurationPushing happens during exhalation, often for shorter bursts, repeated multiple times as needed.
- EnvironmentCommonly used in midwife-assisted, water, or home births where mothers have more autonomy in labor.
Advantages of Open Glottis Pushing
- Promotes better oxygen flow to both mother and baby.
- Reduces maternal exhaustion by allowing more natural breathing patterns.
- Encourages listening to the body’s natural urge to push.
- May decrease risk of perineal tearing or pelvic floor injury.
- Supports a gentler, more gradual birth of the baby’s head.
Disadvantages of Open Glottis Pushing
- May take slightly longer for the baby to descend compared to coached pushing.
- Can be less coordinated in situations requiring medical timing, such as fetal distress.
- Requires more body awareness and confidence, which may be challenging for first-time mothers.
While open glottis pushing may feel more intuitive, it does rely on trusting the body’s signals and may not always be encouraged in highly medicalized settings where staff prefer to control the pace of delivery.
Physiological Effects on the Body
One of the most important differences between open and closed glottis pushing lies in the physiological response. Closed glottis pushing can increase chest and abdominal pressure, which momentarily decreases blood flow to the heart and may lead to short-term oxygen reduction. Open glottis pushing, by contrast, maintains continuous oxygen exchange, preventing the buildup of carbon dioxide and promoting better muscle endurance.
Studies have shown that open glottis pushing tends to result in fewer drops in fetal heart rate, while closed glottis pushing may show more variability in fetal oxygen levels. For women without complications, allowing the body to dictate when and how long to push tends to support a smoother and safer delivery experience.
Comfort and Control During Labor
Comfort plays a crucial role during labor, and the type of pushing technique can influence how empowered or in control a woman feels. Open glottis pushing often allows for more freedom in body positioning such as squatting, side-lying, or kneeling because it works in harmony with natural breathing. Closed glottis pushing, on the other hand, is frequently done in a semi-reclined or supine position, which may limit pelvic mobility and comfort.
Emotional and Psychological Factors
Many women describe open glottis pushing as more intuitive and connected to their body’s rhythm. It promotes calmness and reduces anxiety since breathing remains continuous. In contrast, closed glottis pushing can sometimes feel more mechanical and externally directed, particularly when healthcare staff give timed instructions rather than letting the mother lead the process.
Professional Recommendations
Modern obstetric guidelines increasingly emphasize allowing mothers to follow their natural urge to push rather than enforcing a specific breathing method. Organizations such as the World Health Organization and many midwifery associations recommend open glottis pushing as the more physiological and less stressful method for both mother and baby.
However, there are times when closed glottis pushing may still be appropriate for example, during high-risk deliveries, when the baby needs to be delivered quickly, or if the mother is under epidural anesthesia and cannot feel the urge to push naturally.
How to Practice Pushing Techniques
Expectant mothers can prepare for both pushing styles during prenatal classes or with a birth coach. Learning how to relax the pelvic floor and coordinate breathing helps build confidence. Here are a few preparation tips
- Practice deep breathing and controlled exhalation to simulate open glottis pushing.
- Learn to identify natural urges to bear down during contractions.
- Discuss with your birth provider which method they recommend and under what circumstances.
- Stay flexible labor conditions can change, and adapting your technique is perfectly normal.
Finding the Right Balance
Ultimately, open vs closed glottis pushing is not about which method is universally better, but which one fits the situation and the mother’s comfort level. Some women may naturally alternate between both styles during labor holding their breath for a brief push and then exhaling through the next. Listening to the body, supported by knowledgeable caregivers, is often the best approach.
Both open and closed glottis pushing techniques play important roles in childbirth, each with its own benefits and considerations. Open glottis pushing supports oxygen flow, relaxation, and a more instinctive birthing process, while closed glottis pushing offers controlled pressure and may be helpful in guided medical settings. Understanding how these methods differ empowers mothers to make informed decisions, work with their healthcare team, and have a birth experience that feels both safe and empowering.