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I’ve been thinking about this a lot, as it’s the same in every birth I’ve ever supported (those with epidurals and without). UK hospitals routinely allow passive descent with epidurals - waiting for the baby to move lower before active pushing begins. It’s recognised as safer, more effective, and better for outcomes. But in spontaneous births? The moment someone hits 10cm, it’s often straight to coached pushing. Even when there’s no urge yet. The physiology hasn’t changed. The baby still needs t