OBJECTIVES: To evaluate maternal labour pain, fatigue, duration of the second stage of labour, the women's bearing-down experiences and the newborn infant Apgar scores when spontaneous pushing is used in an upright position. DESIGN: Quasi-experimental study. SETTING: Medical centre in Taichung, Taiwan. PARTICIPANTS: 66 Women giving birth at the hospital, with 33 primigravidas assigned to each group. INTERVENTIONS: During the second stage of labour, the women in the experimental group pushed from an upright position and were given support to push spontaneously; the women in the control group pushed from a supine position and were supported via Valsalva pushing. OUTCOME MEASURES: Pain scores were recorded at two evaluation time points: at 10 cm of cervical dilation and one hour after the first pain score evaluation. One to four hours after childbirth, the trained nurses collected the fatigue and pushing experience scores. FINDINGS: The women in the experimental group had a lower pain index (5.67 versus 7.15, p = 0.01), lower feelings of fatigue post birth (53.91 versus 69.39, p < 0.001), a shorter duration of the second stage of labour (91.0 versus 145.97, p = 0.02) and more positive labour experiences (39.88 versus 29.64, p < 0.001) compared with the control group. There was no significant difference in the Apgar score for newborn infants during either the first minute (7.70 versus 7.73, p = 0.72) or the fifth minute (8.91 versus 8.94, p = 0.64). KEY CONCLUSIONS: The pushing intervention during the second stage of labour lessened pain and fatigue, shortened the pushing time and enhanced the pushing experience. IMPLICATIONS FOR PRACTICE: Pushing interventions can yield increased satisfaction levels for women giving birth.