There are many different ways to push, though most hospitals automatically do directed pushing. Some women prefer directed pushing, which works very quickly. But there are options you should know about. I was unaware that mother-directed pushing even existed, and relied on my husband and nurses counting it out for me. I pushed as hard as I possibly could -- appreciating the chance to work with my contractions instead of merely coping -- and tried to get him out quickly. I did. I pushed for forty five minutes (which is quite fast for a first-time mom), broke blood vessels in my face, chest, and eyes, (they were all red ... it looked scary) and burst Mac out in one push. No head and then shoulders; he came out all at once.
And I tore like crazy.
Next time around, I am going to try to take it slowly, do whatever feels right, and tell my doctor to most definitely NOT numb the perineum; otherwise you can't tell when you've stretched to your limit and need to take a break while your skin catches up.
Watch this great video.