A range of different pushing techniques may be used in the second stage of labour to assist with the birth of the baby. Spontaneous pushing is when women have an instinctive and irresistible urge to push, and may push several times during one contraction. Directed pushing is when women are encouraged to take a deep breath in at the beginning of the contraction and push to the end of that breath, taking further breaths as necessary and repeating to the end of the contraction. Women can push with an open glottis (on exhalation) or closed glottis (Valsalva manouevre). Pushing may either commence as soon as the cervix is fully dilated (immediate pushing), or be delayed from the time of complete cervical dilation to allow a period of passive descent where the uterine contractions alone may propel the baby through the birth canal. In women with regional analgesia (an epidural) in place the urge and ability to push may be reduced, and so a delay may ensure that the baby has descended further into the birth canal before directed pushing is commenced, which may help to shorten the active second stage. There is uncertainty as to whether one pushing technique is more beneficial than another, and whether pushing should be delayed or begin immediately at the time of diagnosis of full dilatation of the cervix. The aim of this review is to identify the benefits and risks of different pushing techniques and identify the optimal pushing technique for birth outcomes and birth experience for women with and without an epidural.