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Labor and Birth Positions

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We all have the medical drama image of a woman in labor, lying in a hospital bed with gritted teeth and stirruped feet, gripping her partner’s hand as the medical team yells to “Push! Push! Push!”

Contrary to this common perception, lying on your back is not your only birthing option. Dramatic childbirth scenes often entirely skip the hours of labor (with many opportunities for different labor positions) that come before it’s time to push.

There is a growing body of evidence that upright positions for labor and birth have many benefits for mom and baby. And yet, the vast majority of women who give birth in U.S. hospitals are still doing so on their back — partly because they’re not aware of the other options.

Many factors influence labor and birthing positions (use of epidural and pain medications, type of fetal monitoring, medical training, hospital culture, etc.). In some cases, it is medically necessary to give birth on your back. And epidural anesthesia (which numbs your body below the waist) might make some upright positions difficult.

But there are a lot of great options for alternative labor and birth positions — some of which (like side lying) can even be used with an epidural in place. So it’s a good idea to explore all your birthing position options and discuss your preferences with your provider before the big day arrives.

There are a lot of benefits to alternative birthing positions. An upright position can:

  • Speed up the process. Certain positions can help speed up or progress labor if needed. And the uterus contracts stronger and more efficiently in an upright position.

  • Use gravity to your advantage. Why work against it when you can work with it? When you’re in an upright position, gravity helps move the baby down and out.

  • Get baby more oxygen. Upright positions can reduce the risk of compression to mom’s aorta, which allows for increased oxygen supply to your baby.

  • Create a wider channel. Upright positions increase the width of mom’s pelvic outlet where baby passes through.

  • Reduce the risk of perineal tearing. Your provider can help you find a position that’s safe and comfortable for you.

Plus, simply switching up positions during labor and birth can help ease pain and anxiety and is associated with higher satisfaction rates around birthing. Below are several options for labor and birthing positions, categorized by which positions many women find preferable during “early” and “active labor” (while your cervix is dilating), and for pushing (after you’re fully dilated). You can use any position at any point during your labor. But you might prefer more active, upright positions in early and active labor and at the beginning of the pushing phase (“early pushing”), saving positions that allow you more rest for “late pushing.”

Remember: These are just a few options and should not replace medical advice from your provider. We suggest bringing this list into your next appointment so you can go over these options with your provider before birth.

Active Labor

Standing and Walking

Walking uses gravity to your favor and can make you feel more in control. This position can also help the baby move into a good position for the second stage of labor.

  • During contractions, lean into a wall, your partner, or a nearby railing or counter.

  • As you lean, apply some pressure to your pelvis to help ease pain.

Slow Dancing

This position allows you to be mobile, but also helps you conserve energy. If you have a partner present, it allows them to be more actively involved, too.

  • Wrap your arms around your partner or another person’s neck.

  • Slowly sway side to side.

  • During contractions, move your hips in sync to increase comfort and help the baby descend.

Hands and Knees

This position might be preferable if you are experiencing low back pain.

  • Get on your hands and knees with your knees positioned inward, and ankles outward. (This will help open up your pelvis.)

  • Gently rock back and forth or side to side.

  • Your partner (if present) can apply a warm or cold compress to your spine for relief.

  • During contractions, you can drop your buttocks towards your heels (child’s pose).

Rebozo

This position can help ease discomfort in your pelvis or low back and may also help your baby rotate into a favorable position (especially if your baby is face up).

  • While on your hands and knees, have your birthing partner hold a rebozo (woven shawl) or sheet (about five to seven feet long) around your belly.

  • Use tiny, gentle, jiggling movements to shift the rebozo or sheet from side to side.

Ball Rocking

This position can promote pelvic opening through relaxed, rhythmic movement.

  • Sit on a large exercise ball or birthing ball.

  • Rock front to back or side to side.

  • Try to keep your knees lower than your hips to allow room for the baby to rotate.

  • As an alternative, you can also kneel in front of the ball and rest your chest, arms and head on the ball.

  • Note: You may need support from a wall, sturdy object, or your birthing partner during contractions.

Backward Sitting

This position can reduce some pressure in your back. It also affords your partner (if present) to rub your back if that comforts you.

  • Sit backward on a chair if you are unable to stand upright or move around.

  • As an alternative, you can try sitting on a toilet to help relax your perineum.

  • During contractions, place a large pillow (or multiple smaller pillows) between you and the chair and lean forward into the pillow.

Early Pushing

Squatting

This position opens your pelvic inlet (the top of your pelvis) but closes your pelvic outlet (the bottom of your pelvis), making it a more effective position in early phases of pushing. Done in later stages, squatting can actually increase risk of tearing.

  • Sink down into a deep squat, using a wall, rebozo, partner, squatting bar, or sturdy piece of furniture for support.

  • Try to keep your knees behind your toes.

  • You can also try a semi-squat position where one leg is bent and the other is extended straight to your side. (Try both sides to see if one feels better than the other.)

  • You can also try a supported squat with a yoga block or stack of books underneath your pelvis to preserve energy.

Lunging

This position will allow your mid pelvis to open. It’s particularly helpful if labor stalls.

  • Stand in a side lunge position with one foot propped on a chair, toilet, or stairs. Make sure your elevated foot is at a 90-degree angle from your body (like a warrior 2 yoga pose).

  • Use your partner or provider for support.

  • During contractions, gently lunge into your elevated foot and rock back and forth.

Late Pushing

Lying on Your Side

This position is best for later stages of pushing or if you had an epidural. It’s also linked to lower rates of tearing because it allows your tailbone to open (as opposed to if you were on your back).

  • Lie on your side with a peanut ball or pillow.

  • You can also have your partner supporting your top knee.

  • Breathe and let this passive position give your body a break so your uterus can do its job. (If you’re exhausted, your uterus is exhausted too.)

Lying on Your Back

This is a very common position and it can help you conserve energy needed for late pushing. It’s best saved for late pushing since it can restrict pelvic opening.

  • You can either elevate the head of the hospital bed so you are more in a seated, upright position or elevate yourself with multiple pillows or a bolster.

  • Position a rolled up towel secured with rubber bands (about three to four inches) under your pelvis to give your sacrum greater mobility.

Key Takeaways

  1. Lying on your back is not your only delivery option. Evidence shows that upright positions for labor and birth have many benefits for mom and baby.

  2. Upright positions have health benefits (like reduced risk of perineal tearing) as well as emotional benefits (like reduced anxiety during labor).

  3. Some positions are best for different phases of labor and birthing, such as early or active labor, early pushing, and late pushing.

References

  1. Approaches to Limit Intervention During Labor and Birth. (2019). Acog.org. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth

  2. Dekker, R. (2018, March 20). Evidence on: Birthing Positions - Evidence Based Birth®. Evidence Based Birth®. https://evidencebasedbirth.com/evidence-birthing-positions/

  3. Herman & Wallace Pelvic Rehabilitation Continuing Education - Darla Cathcart, PT, DPT, WCS, CLT. (n.d.). Hermanwallace.com. https://hermanwallace.com/faculty/darla-cathcart

  4. The 7 Best Labor Positions for a Comfortable Delivery. (n.d.). What to Expect. https://www.whattoexpect.com/pregnancy/labor-and-delivery/delivery-options/labor-positions.aspx

  5. Women’s position for giving birth without epidural anaesthesia. (n.d.). www.cochrane.org. https://www.cochrane.org/CD002006/PREG_womens-position-giving-birth-without-epidural-anaesthesia