Overview

For most of human history, a mother in labor was free to move around and change positions at will, with the most common positions being upright. In the mid-1600s, obstetricians started putting mothers on their backs. Thankfully, in recent years, more evidence has supported allowing a mother to choose the positions in which she labors. How your body is positioned during labor can significantly impact the discomfort of contractions, your baby’s ability to descend, the likelihood of some interventions, and even the length of your labor. Learn what positions are most helpful in specific labor stages, tools to make positions easier, and how to modify positions when birth interventions affect your mobility.

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How Labor Progresses

Labor is a marathon and will be the most physically challenging event of your life. You and your baby will both be working hard to meet each other. The positions you choose to labor in can significantly impact the discomfort of contractions, your baby’s ability to descend, the length of your labor, and what interventions are required. Let’s start with a basic understanding of the stages of labor so you understand how labor progresses.

First Stage 

The first stage of labor starts when labor begins and ends when your cervix dilates (widens) to 10 centimeters and effaces (thins) to 100%. This stage is primarily letting your body do what it needs to do, and you are just along for the ride. Your job is to find ways to manage contractions and let your body work. This is generally the longest stage and can be broken down into the latent and active phases. 

The Latent Phase 

The latent phase is from the start of labor until you are dilated to 6 cm. This stage is considered prolonged if it lasts more than 20 hours for a first-time mother. If this is not your first baby, it tends to be shorter and is considered prolonged after 14 hours.

You will likely be home for much of the latent phase. Remember that labor is a marathon. If you can, rest and try to get some sleep. This also goes for your birth partner. They must be there 100%, so they should be well rested, too. This is also an excellent time to eat something. You will expend a lot of energy, and your body needs fuel.

The Active Phase 

The active phase is when your cervix dilates from 6 to 10 cm. In this phase, your cervix changes more rapidly and predictably. Typically, at a rate of around 1.2-1.5 centimeters per hour. If this is not your first baby, dilation will likely be faster. Doctors and midwives generally advise that you go to the hospital or birth center in active labor.

As labor progresses, contractions will continue to get longer, stronger, and closer together. Changing positions aims to get you as comfortable as possible during contractions, but don’t forget you have breaks between them. If you are going through a challenging contraction, remember it will not last forever, and you will get a break soon. 

Second Stage 

The second stage of labor is the pushing stage, from being fully dilated at 10 cm until your baby is born. The best way to describe pushing is like you are bearing down to make a bowel movement. For first-time mothers, the second stage is considered prolonged if it lasts longer than three hours without an epidural or four hours with an epidural. Like the first stage, the second stage is usually quicker if this is not your first baby.

Interventions that can Affect Your Mobility

Some common birth interventions can affect your ability to move around. Any interventions come with pros and cons, and although these may affect the positions you can be in during labor, you may decide the benefits outweigh any limitations on positions. The goal of talking about how these interventions affect your mobility is to allow you to find ways to modify positions to be compatible with the birth interventions you use.

Epidurals

Nearly one in four mothers use an epidural during labor. Epidural administration is a method of administering medication into the epidural space around the spinal cord. An epidural significantly relieves pain and allows you to remain awake. Plus, you can still feel pressure, which is helpful during the second (pushing) labor stage. Epidural administration allows continuous administration so your care provider can adjust to your needs throughout labor and birth.

The medicines in an epidural decrease your sensation in the lower half of your body. This is beneficial for relieving pain, but it may bring additional challenges. Depending on how numb you are with an epidural, you may have difficulty telling when you are having a contraction, and this can make pushing difficult to control. You may also be restricted to a hospital bed if you cannot stand safely. Thankfully, nurses and hospital staff are very helpful in assisting you with positions within your limitations. 

IV Fluids, Catheters, and Electronic Fetal Monitoring

IV fluids, a catheter, and electronic fetal monitoring commonly accompany epidurals. These interventions are not exclusive to having an epidural, and even if you plan an unmedicated birth, you could still utilize these interventions.

IV fluids require an IV line attached to the top of your hand connected to an IV pole. If, for example, you need to go to the bathroom, you will be tethered to an IV pole and will need to take it with you. 

An epidural may make it difficult to tell when you need to urinate. As a result, you could have a catheter to empty your bladder. This involves a thin tube inserted into your bladder to empty the contents into a collection bag. According to one study, about four out of five women who have an epidural require a catheter at some point during their labor. This limits your mobility to a hospital bed.

Epidurals are also accompanied by electronic fetal monitoring to monitor your baby’s heart rate and assess how they are tolerating labor. Electronic Fetal monitoring uses instruments to continuously record the heartbeat and the baby and the contractions of the uterus during labor. The machine used is a cardiotocograph or CTG, more commonly known as an electronic fetal monitor. Electronic Fetal Monitoring is most often done with a pair of belts wrapped around your abdomen. One of the belts uses a Doppler to detect your baby’s heart rate, and the other measures the length of contractions and the time between contractions. With continuous electronic fetal monitoring, you will be connected via wires to the CTG machine, so you may not be able to move or walk around much. 

Labor Positions

Now that you understand how labor progresses and how some interventions may affect your mobility let’s explore labor positions you can experiment with.

Laboring on Your Back

For most of human history, a mother in labor was free to move around and change positions at will, with the most common positions being upright. In the mid-1600s, obstetricians started putting mothers on their backs. This change resulted from a shift in the focus from the birthing mother to the doctor delivering the baby. A patient on her back in a bed made a doctor’s job much easier. Some of the negatives of lying on your back with your legs raised are that it works against gravity, your major blood vessels are compressed, and there is a higher probability of a vaginal tear or an episiotomy.

Upright Positions

You want to work with gravity, not against it. Especially during the first stage of labor, when you are dilating and effacing. In a review of women during the first stage of labor overall, it was concluded that there is clear and important evidence that walking and upright positions in the first stage of labor reduces the duration of labor, the risk of cesarean birth, the need for epidural, and does not seem to be associated with increased intervention or negative effects on mothers’ and babies’ well-being. These differences were significant. Upright positions shortened labor by approximately one hour and 22 minutes.

Standing and Walking

Standing and walking can be especially helpful in the early stages of labor. This use gravity to encourage your baby to descend further into your pelvis. It helps deliver more oxygen to your baby, it may speed up labor, and it may make contractions more comfortable for you than if you were sitting or lying down. A walk is also a great distraction to kill some time in the earliest stage of labor.

Rhythmic Moving Like Swaying or Rocking

You may also find rhythmic moving, like swaying or rocking, helpful.  You can lean on your partner against a wall or hold onto anything during a contraction. If swaying is helpful, you can wrap your arms around your partner’s neck as if you are slow dancing. If rocking helps, you can stand and hold on to a countertop, sit on the edge of a bed or a chair, or use a wall to help support you. Rocking or swaying, even if you are sitting on a chair and not standing up, allows your pelvis to move, encouraging your baby to move further down, which is precisely what you want.

Lunging

Lunging may help your baby rotate if they are not in the optimal position and can help them descend. For a lunging position, you can put one foot on a chair or something lower, like a step or a stool, then gently lean your weight toward the raised foot during your contraction.

Sitting

Sitting on a bed or a chair is also an option. It may be helpful to use pillows to support your back if you are reclining, or you can try leaning forward, which can take some pressure off your back. Another option is to sit with your partner behind you so that they can support you. You are still upright when sitting, so gravity will work in your favor. This is also a position that you can use if you have an epidural or electronic fetal monitor. Sitting in bed or your partner’s arms can make contractions more comfortable and allow gravity to assist in bringing your baby down into the birth canal.

Another take on a sitting position is sitting backward on an armless chair or toilet. If you are sitting on a chair, you can put a pillow between your belly and the back so you can lean into it more comfortably, and try resting your head or arms on the back of the chair. If you are experiencing back pain, leaning forward may help remove some pressure from your back. A big pro of this position is that it is perfect for your partner to message you. You could also do this in the shower if you have a plastic chair that would fit in your shower, and you can let the warm water fall on your back, which you may find soothing.

Hands and Knees

Back labor can be uncomfortable as your baby puts pressure on your lower back, just above your tailbone. A position on your hands and knees is another great way to help ease back labor because it takes pressure off your spine. Getting on all fours may not sound glamorous, but it is a really popular position.

You can do this on the floor at home or on a bed in a hospital or birth center. It can be helpful to put some pillows below the top half of your body to help support you. If you are in a hospital bed, try raising the bed so you can lean on your forearms if your wrists are sore. This position will help open up your pelvis and use gravity to help your baby move further down. This position can be used if you are hooked to a fetal monitor. Hands and knees are a great position for massage, and it is also fantastic for your partner to apply counter pressure to your lower back. 

Lying on Your Side  

If you need a break and want to rest, try lying on your side. This position is excellent if you have high blood pressure, an epidural, or are being continuously monitored. This position can also help get more oxygen to your baby if you are lying on your left side, as that will maximize blood flow to your uterus and your baby. This also lets you relax between contractions. Another option for this position is to draw your knees into your chest. Lying on your side is preferable because it doesn’t compress major blood vessels like lying on your back. Lastly, a side-lying position could slow a birth that moves too quickly. 

Positions for the Second Stage of Labor

Many of the positions thus far will help you during labor. A few will be especially helpful during the second (pushing) stage. Any position in which you are upright, just not lying down, will keep gravity on your side and working in your favor, especially during the pushing stage. 

Squatting

Squatting, in particular, is fantastic for the pushing stage.This encourages your baby to descend downwards, better than any other position. Plus, when you squat, the opening of your pelvis increases, giving your baby more room. You can still shift your weight and maintain some movement while squatting down. It is great for blood circulation to your baby; it may increase their rotation, and overall squatting makes it easier for your baby to make it out. This position is also great for the physical act of pushing. A downside of this position is that it can be tiring.

Tools to Make Squatting Positions Easier

There are a lot of different tools and techniques you can use to make squatting easier during labor.  First, start doing squats. I’m not talking about when you go into labor; I am talking about doing squats today while you are pregnant. If you work on squatting during your pregnancy, two things will happen. One, your butt is going to look amazing, and two, when you are in labor, you will be stronger and better able to squat down, which theoretically could speed up your labor.

Aside from regularly practicing squats, you can squat with your back against a wall or hold onto a chair.  If you are having trouble squatting down and staying in that position, you can also try holding hands with your partner; they can help support you while you squat down.

Supported Squat

You can try standing in a supported squat. You are standing up in this position, but your partner is supporting some of your weight. The simplest way to do this is for your partner to stand behind you and put their arms around your chest so they can support some of your weight, while you are half standing, half squatting. Or you could try this with both of you sitting down as well. An advantage of this position is that it realigns your pelvis and increases the opening, lengthens your trunk, and helps your baby line up with the angle of your pelvis. The movement will also assist your baby in moving further down the birth canal. This gives you a little break because your partner supports some of your weight.

Positional Tools

Some tools can assist you in getting in or staying in a position longer or with less effort. You may consider incorporating these into your labor at home or when you go to a hospital or birth center.

Birth Ball

A birth ball is a large rubber exercise ball you can sit or lean on. You can sit on the ball in a squat position and benefit from opening your pelvis while the ball supports your weight. You could also kneel and lean over a birthing ball to support your weight in a hands-and-knee position. If you feel unstable on a birth ball, your partner or someone else can help support you. If you purchase a birth ball, I recommend buying the largest size. You can always remove some air to make it smaller. 

Peanut Ball

A peanut ball is similar to a birth ball but is smaller and shaped like a peanut. This is a good tool to place between your legs and keep your pelvis open while lying on your side. 

Birthing Stool

Another tool you may have available at a hospital or birth center is a birthing stool. This short U-shaped seat helps support you while you are in a squatting position. 

Squatting Bar

Most hospitals will have a squatting bar arched over the foot of the bed. This allows you to rest between contractions, and when you feel a contraction coming. Then you can grab the bar and pull yourself up to a squatting position. This may not be ideal if you have an epidural and your legs are too numb to support you in a squatting position safely. In this case, you can rest your feet on the vertical supports of the bar and loop a sheet or towel over the top. During a contraction, you can pull back on the sheet as you push downward.

Bed Sheet

You can also create support for squatting with a bed sheet and a door. Tie a knot in one end of the sheet, hang the knot over the top of a door, and securely close the door. The knot keeps the sheet in place, and you can hold the other end as leverage to help you squat down. As with any of these positions, if you have any concerns about safety or stability, you can always avoid it.

If you want to incorporate any of these tools, ask your doctor or midwife whether they will be available at the venue where you plan to have your baby or bring your own.

Involving Your Partner

When you are in labor, you will not think 100% clearly. You can study this stuff for your entire pregnancy, and may still not recall all of the positions in labor. This is an area where your partner can come in handy. Review these positions with your partner so your partner can assist when you are preoccupied with giving birth. Plus, they will know what to do for the positions requiring direct involvement. If you are unsure how the logistics work of a position like a supported squat with your partner, try it so both of you know what it looks like and you aren’t fumbling around when you are actually in labor. If you have a doula, they will also be an excellent resource for ideas for different positions.

Additional Research on Labor Positions

A study compared women giving birth in an upright position to women who labored and gave birth lying down. Women who used upright positions more than 50% of the time had more effective uterine contractions and more perineal muscle relaxation, and their births were significantly shorter. In addition, they had lower rates of requests for epidurals or other medication, fewer assisted deliveries, and fewer cesarean sections.

A review found that women who labored during the second stage in an upright position had a 27% decrease in assisted deliveries, a 7% decrease in episiotomies, and fewer abnormal fetal heart rate patterns. The researchers concluded that women should be allowed to choose the birth positions they might wish to assume for the birth of their babies.

The Best Position for Labor

What is the absolute best position for labor? This is up to you, and the answer is the one that is the most comfortable for you at that particular moment. You can see evidence showing a benefit to being in an upright position. Overall, the studies show that you should be free to move as you see fit. I urge you to trust your body. If you are uncomfortable, change positions. If your body tells you to stand up, move around, lay down, and rest, do that. In the event you have any limitations due to interventions during your labor and birth, work with your care provider to find the best positions for those circumstances.

The official opinion of the American College of Obstetricians and Gynecologists is that observational studies of maternal position during labor have found that women spontaneously assume many different positions during labor. There is little evidence that any one position is best. Moreover, the traditional supine position (lying on your back) during labor has known adverse effects, such as supine hypotension and more frequent fetal heart rate decelerations. Therefore, for most women, no one position needs to be mandated or proscribed.

Adding Tools to Your Birth Tool Box

How well you manage contractions depends on what techniques you have learned or practiced and what works best for you. Having positions to try and knowing which ones are most effective is one tool to keep in your toolbox for labor. The more tools you have, the better. You can set up your birth room environment to be a calming, safe environment. You may utilize hydrotherapy, different breathing techniques, or hypnobirthing. Learn about more tools in this episode.

Including Labor Positions in Your Birth Plan

Addressing specific positions you want to try or avoid is a topic you could include in your birth plan. Although, I recommend limiting your birth plan to one page and only printing on one side. Keeping your plan short requires narrowing it down to the most important preferences. It may not be necessary to list out preferences for labor positions if there are higher priorities. The Pregnancy Podcast has several resources to help you create your birth plan: 

• Guide to Creating Your Birth Plan 
• Get a copy of Vanessa’s birth plan
• Your Birth Plan book (FREE for Premium Members) 

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