How is coached pushing done?
In most cases, a labor and delivery nurse leads the coaching. Typically, you're told to take a deep breath at the beginning of every contraction, hold it, and push—by tightening the abdominal muscles and trying to exert as much downward pressure as possible—while the nurse counts to ten. (Some moms say it feels like they're straining to have a bowel movement.) Then you take a quick breath and push for another count of ten, aiming to get three pushes in for each contraction.
The coaching usually begins as soon as the cervix has dilated a full 10 centimeters, which marks the beginning of the second stage of labor, and may continue until just before the baby is born. The pushing stage can last from a few minutes to several hours. To avoid tearing, you may be told to refrain from pushing at the moment the baby's head is crowning—when the widest part is coming through the opening of the vagina.