Congratulations, you are completely effaced and dilated to 10 cm -- you're ready to push out a baby! Or are you?
Many of us have come to believe that pushing during birth begins when you have reached the magical 10 cm. But in fact, there is a beneficial practice that can come before pushing called "laboring down." Instead of forcefully and actively pushing with each contraction immediately after reaching 10 cm, laboring down allows your body to naturally bring baby further down and rotate while you follow only natural, gentle urges to push (or not push at all). This process can last for up to 1 to 2 hours.
Pushing is hard work, and while many women find it satisfying to begin working with their contractions by pushing, it can be helpful to allow yourself a span of time to let your body do the work naturally before exerting the energy it takes to push out your baby. First-time moms may push for 1-3 hours, or it could be 10-20 minutes. And because it's impossible to predict the amount of time you'll spend pushing, laboring down is an effective way to help you conserve energy by reducing the amount of time spent actively pushing.
Similar to laboring down, some women may experience a "rest and be thankful" phase after reaching 10 cm. With this normally occurring phenomenon, labor seems to "stall" and you experience no natural urge to push for around an hour after completing dilation. Instead of pushing with each contraction during this time (which exerts a lot of energy), you may want to consider waiting until you have the natural urge to push. Like laboring down, rest-and-be-thankful allows your body to rotate and bring baby down without exerting a lot of energy on your part.
So whether you're laboring down or resting and being thankful, when should you start pushing? When you begin to feel the overwhelming urge to forcefully bear down with your contractions, it's a good sign to go ahead and push. If your urge to push isn't overwhelming (or if you never feel the urge, as is common when you have an epidural), you can wait until your baby's head is visible (your partner or care provider can let you know).