You will know when it's time to push in much the same way you know when it's time to go...
You will know when it's time to push in much the same way you know when it's time to go to the bathroom. We don't just mean that it's an obvious, instinctive understanding... it's really a lot like the feeling you have to go right now. A very common description for the pushing urge is "intense pressure." That undeniable urge to push is triggered by the pressure of your baby's head against your pelvic floor. You might also catch yourself grunting and/or otherwise automatically working along with your body to push this baby out. The pushing urge usually kicks in at the end of transition, when you are dilated to a full 10 centimeters, and it heralds the beginning of the end! Many women consider it to be the most rewarding part of birth, because they actually have something they can do, rather than just being a slave to the contractions. If you haven't completely dilated, however, your caregivers will encourage you to try to stop pushing so you don't bruise what's left of your cervix, possibly causing it to swell. Not pushing is about as easy to do as trying not to close your eyes while you sneeze. You will usually attempt to work against the urge by "hah hah hah" open-mouth panting, which is usually way easier said than done. (You may also be asked not to push if your caregiver isn't in the room, or they're waiting for some medical equipment/personnel for the baby.) Here is how four different moms described the pushing stage of birth:
I was starting to feel pressure like a BM, and the nurse asked me if I was feeling pressure, and I said yes. She checked me again and walked quickly away saying we were gonna have a baby. - Barb [The nurse] checked me and said I was at nine and just had a bit of lip left. She smiled and said, "Let's have ourselves a baby!" The warmer was rolled into the room. I was so emotional and in so much pain by that point. Then, BOOM, pressure... unbelievably intense pressure. My contractions still hurt, but changed -- I needed to push! Another check and I was at 10cm and complete! I could feel Ellie's head coming down. I was pushing hard with every contraction... I became so intensely tired. I said I needed to sit one out and they said, "That's just fine." I wished I hadn't. Despite my sheer exhaustion, the intense pressure made me need to push and it felt much worse not pushing. - Night I had a hard time knowing how to push because of the epidural. I think I only could push good when my midwife had her fingers down there applying pressure, so that I knew what to push against. - Cookie Just push as hard as you can as if you are pushing out of your bum. To me it felt like I was really constipated and pooing a watermelon! - Tamarin
As Cookie hinted at above, an epidural can diminish or completely remove the pushing urge. If your epi is still going strong by the end of transition, you may need guidance on how and where to push. Your body, meanwhile, will know what to do and will proceed with the plan, even if you're not aware of what's happening. Here's some more good stuff on this topic:

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