Labor Positions: Best Birthing Positions for Delivery

Why Is It Good to Change Positions During Labor?

Changing positions during labor helps the baby descend into the pelvis, can reduce pain, and may shorten the duration of labor. Research shows that women who move freely during labor have shorter first stages and report less pain. Your midwife will help you find comfortable positions throughout the process.

Labor is a dynamic process, and your body naturally wants to move. Staying in one position for too long can cause fatigue and may slow labor progress. The benefits of changing positions frequently include better blood flow to the uterus and baby, reduced muscle tension and fatigue, and the ability to respond to what your body needs at each stage of labor.

During early labor, movement and activity can help contractions become more regular and effective. Walking around, swaying your hips, or using a birth ball keeps you comfortable while encouraging the baby to move down into the pelvis. As labor intensifies, you may instinctively want to change positions with each contraction, finding what helps you cope with the sensations.

Research from the Cochrane Collaboration shows that women who remain upright and mobile during the first stage of labor have labors that are approximately one hour shorter than those who lie down. This is because upright positions use gravity to help the baby descend and allow the pelvis to move more freely.

Sometimes labor needs to be slowed down, for example during the pushing stage if things are progressing very quickly. In these cases, your midwife may suggest more recumbent positions like side-lying. Other times, labor may need encouragement, and upright positions can help. The key is flexibility and responsiveness to how your labor is progressing.

What Equipment Is Available for Different Positions?

Birth units typically provide equipment to support different labor positions, including birth balls, beanbags, adjustable beds, birth stools, squatting bars, and special supports for legs. These tools help you maintain comfortable positions without exhausting yourself.

Modern birth units are equipped with various aids to help you find comfortable positions during labor. The specific equipment available may vary between facilities, but most will have a selection of helpful tools. A birth ball (also called a labor ball or Swiss ball) is one of the most versatile pieces of equipment, allowing you to sit, lean, bounce gently, or rock your hips during contractions.

Beanbags or large pillows provide soft support for kneeling, leaning forward, or resting between contractions. They can be positioned against the bed or on the floor, conforming to your body shape. Adjustable hospital beds can be raised, lowered, and tilted to support various positions from semi-sitting to nearly upright.

Some birth units have birth stools, which are low, curved seats that support you in a squatting position without requiring you to hold the squat yourself. These can be particularly helpful during the pushing stage. Squatting bars attach to the bed and give you something to hold onto while squatting or semi-squatting.

Your birth partner can also serve as important equipment. Leaning on a partner, hanging from their neck during contractions, or having them support you from behind in a squatting position can be invaluable. Your midwife will show you how to use available equipment and may suggest specific items based on how your labor is progressing.

What Are the Benefits of Standing and Walking Positions?

Standing and walking during early labor helps contractions become more regular and effective, uses gravity to help the baby descend, and allows the pelvis to move freely. Many women find that standing and leaning forward during contractions reduces pain, particularly back pain.

During the early stages of labor, staying upright and mobile is often the most comfortable and effective approach. Walking helps labor progress by encouraging regular, effective contractions. The rhythmic movement of walking naturally rocks the pelvis, helping the baby move into the optimal position for birth. Many women find that walking during early labor helps them cope with contractions and feel more in control.

Standing positions allow gravity to assist the baby's descent into the pelvis. When you stand, the weight of the baby naturally presses down on the cervix, which can help with dilation. Standing also allows your pelvis to move more freely than when lying down, which helps the baby navigate through the birth canal.

During contractions, many women find relief in standing and leaning forward onto something stable. This might be a wall, the raised head of a bed, a birth partner, or a special support called a walking frame or gait trainer. Leaning forward takes some weight off your feet while keeping you upright. It also tilts the uterus forward, which can reduce back pain.

The ideal standing position involves having your feet wider than hip-width apart with slightly bent knees. This allows your pelvic floor muscles to relax and gives the baby more room to descend. Swaying your hips or rocking gently from side to side can feel comforting and may help the baby rotate into a good position.

While standing positions are excellent during the first stage of labor, it is relatively uncommon to give birth standing up. The position can make it difficult for your midwife to assist and monitor the birth, and there may be an increased risk of perineal tears because it is harder to control the speed of delivery. If you want to try pushing while standing, close communication with your midwife is essential.

Resting while upright

You do not have to keep walking throughout labor. It is possible and important to rest even while maintaining an upright position. You can rest by leaning forward against a beanbag, sitting on a birth ball and leaning onto a bed, or having your birth partner support you in a standing position during rest periods. The key is to avoid lying flat on your back for extended periods, as this can reduce blood flow to the baby.

How Does the Hands-and-Knees Position Help During Labor?

The hands-and-knees position relieves pressure on the lower back, helps babies in posterior position rotate, gives you good pushing power, and reduces the sensation of rectal pressure. This position is particularly beneficial for women experiencing back labor.

Getting onto your hands and knees, also called the all-fours position, is one of the most effective positions for managing back pain during labor. When you are on hands and knees, gravity pulls the baby's weight away from your spine, reducing the pressure that causes back pain. This position is especially helpful when the baby is in a posterior position, meaning their back is against your back.

The hands-and-knees position allows the pelvis to move freely, which can help the baby rotate from a posterior position to the more favorable anterior position where the baby's back is toward your belly. Rocking your hips or making circular movements while in this position can encourage rotation. Many midwives recommend this position specifically for babies that are slow to descend or seem to be in a less optimal position.

During the pushing stage, hands-and-knees can provide excellent pushing power. The position opens the pelvis and allows you to use your abdominal muscles effectively. You can alternate between being more upright on your knees during contractions and leaning forward to rest between them. This rhythmic movement can help pace the delivery.

Another benefit of the hands-and-knees position is that it reduces the uncomfortable sensation of the baby's head pressing against the rectum. Many women find this pressure one of the most challenging aspects of labor, and being on all fours can significantly reduce this discomfort. If labor is progressing very quickly, this position can help slow things down, giving the perineum more time to stretch.

The hands-and-knees position can be made more comfortable by placing a pillow or folded blanket under your knees. You can rest your upper body on a beanbag, birth ball, or the raised head of the bed. If your wrists tire from supporting your weight, you can come down onto your forearms while keeping your hips elevated.

What Are the Advantages of Squatting During Birth?

Squatting opens the pelvic outlet by up to 28%, uses gravity to assist delivery, and can be very effective for pushing the baby out. However, it can be difficult to maintain without support and may increase the risk of tearing if the delivery is too fast. Close cooperation with your midwife is essential.

Squatting is one of the oldest birthing positions used throughout human history. The position has significant physiological advantages because it widens the pelvic outlet. Research shows that squatting can increase the diameter of the pelvic outlet by up to 28% compared to lying on your back. This gives the baby more room to pass through and can be particularly helpful if the baby is large or if the pelvis is narrow.

The gravitational advantage of squatting is significant. In a full squat, gravity pulls directly downward, assisting the baby's descent. The position also naturally aligns the birth canal, making it easier for the baby to navigate through the pelvis. Many women report feeling powerful and in control when squatting during labor.

However, squatting has some challenges. Maintaining a full squat requires considerable leg strength and can be exhausting, especially during a long labor. Most women need support to squat effectively, either from a birth partner behind them, a squatting bar attached to the bed, or a birth stool. Without support, the position may not be sustainable.

One concern with squatting is that it can make the pushing stage progress very quickly, which may not give the perineum enough time to stretch gradually. This can potentially increase the risk of perineal tears. Studies have shown somewhat mixed results, with some suggesting increased tear rates in squatting positions. Because it can be difficult for the midwife to see what is happening and to provide support to the perineum, very close communication between you and your birth team is essential if you want to squat during delivery.

A modified squat or supported squat may offer the benefits of the position while being more sustainable and allowing better monitoring. You can squat while holding onto a bar or your partner, using a birth stool, or being supported under the arms from behind. These variations allow you to rest between contractions while still benefiting from the open pelvis during pushing.

How Does Using a Birth Stool Work?

A birth stool supports you in a seated-squat position, opening the pelvis while allowing you to rest your leg muscles. It provides good support for the pushing stage, and a birth partner can sit behind you for additional support. Birth stools combine the advantages of squatting with more sustainability.

Birth stools have been used for centuries and remain popular in modern midwifery. A birth stool is a low, curved seat that supports you in a position similar to squatting but without requiring you to support your full weight on your legs. The horseshoe shape of most birth stools allows access for delivery while still providing stable seating.

Using a birth stool offers many of the same benefits as squatting. The position widens the pelvis, uses gravity to assist delivery, and allows you to push effectively. Because your weight is supported by the stool, you can maintain the position for longer periods without exhausting your leg muscles. This can be particularly helpful during a prolonged pushing stage.

The birth stool allows you to relax your thighs and buttocks, which helps the pelvic floor muscles to also relax. This relaxation can help the baby descend and may reduce the amount of pushing effort required. Many women find the position intuitive and comfortable, feeling that they can work with their body effectively.

Having a birth partner sit behind you while you use a birth stool provides additional support. They can support your weight between contractions, offer massage or encouragement, and help you maintain a good position. This teamwork often helps women feel secure and supported during the intense pushing stage.

As with squatting, close cooperation with your midwife is important when using a birth stool. The position can accelerate delivery, so communication about when to push and when to ease off is crucial to allow controlled delivery and reduce tear risk.

What Are the Benefits of Kneeling Positions?

Kneeling while leaning forward against a raised bed head or support takes pressure off your back while keeping you upright. This position is comfortable for many women, allows the midwife good access for monitoring and assistance, and can be easily modified for rest or active pushing.

Kneeling positions combine the benefits of being upright with good stability and versatility. The most common kneeling position involves kneeling on the bed facing the raised head of the bed, which you can lean against for support. A beanbag or pillow between you and the bed head can make this more comfortable.

This position keeps you upright, allowing gravity to assist the baby's descent. Because you are leaning forward, it tilts the uterus toward your front, which can relieve back pain and help the baby rotate into a good position. The kneeling position also allows your pelvis to move freely, which helps the baby navigate through the birth canal.

One advantage of kneeling is that it is relatively easy for your midwife to monitor the baby and provide assistance if needed. Unlike some other upright positions, the midwife can clearly see what is happening and can support the perineum during delivery if necessary. This makes kneeling a good choice if you want to be upright but also want your healthcare team to be able to help effectively.

Kneeling positions are easily adaptable. During contractions, you might be more upright on your knees, actively pushing. Between contractions, you can lean forward and rest against the support, or even sit back on your heels to take weight off your knees. This flexibility helps you manage energy throughout labor.

A forward-leaning kneeling position can also help relieve pressure on your back during the pushing stage. This can be particularly valuable if you have been experiencing back labor. By alternating between kneeling and other positions, you can find what works best at each stage.

If your knees become uncomfortable, placing a soft blanket or pillow underneath them helps. You can also try having one knee up and one knee down, which changes the angle of the pelvis and may help the baby descend or rotate.

What Is the Semi-Recumbent Position and When Is It Used?

The semi-recumbent or semi-sitting position is one of the most common birthing positions. While comfortable and allowing eye contact with your healthcare provider, it does not fully utilize gravity. Using pillows for support and keeping knees drawn up can help open the pelvis.

The semi-recumbent position involves sitting at about a 45-degree angle, propped up by pillows or the raised head of the bed. This is one of the most frequently used positions in hospital births because it is comfortable, stable, and allows good visibility for healthcare providers. However, it is not necessarily the most physiologically optimal position for birth.

In the semi-recumbent position, you are essentially pushing uphill against gravity. The baby must travel upward and then curve down through the birth canal, which is less efficient than positions where gravity assists the descent. This can mean more effort is required for pushing and potentially a longer second stage of labor.

Despite these limitations, the semi-recumbent position has some advantages. It allows you to maintain eye contact with your midwife, which many women find reassuring during the intense pushing stage. It is also comfortable for extended periods and does not require significant physical effort to maintain. For women who are tired after a long labor, this position allows them to rest between contractions while still being able to push effectively.

The position can be improved by keeping your knees drawn up toward your chest, which helps open the pelvis. Having a beanbag or birth partner behind you for support can help you curve forward during pushing, making your efforts more effective. Some women find it helpful to hold the backs of their thighs or use a sheet or rope to pull against during contractions.

The semi-recumbent position is often preferred when continuous fetal monitoring is needed, as it allows good access for monitoring equipment. It may also be recommended in certain medical situations or when you have had an epidural and have limited mobility. Your midwife can help you make the most of this position while suggesting modifications to improve comfort and effectiveness.

How Does Lying on Your Side Benefit Labor?

Side-lying is an excellent position for rest, can help slow down a fast labor, and may reduce the risk of perineal tears. Many women find it comfortable for delivery, and it allows good control over the pace of pushing. The position is gravity-neutral but offers excellent perineal protection.

Lying on your side during labor offers unique benefits that make it valuable in many situations. While you do not get the gravitational advantage of upright positions, side-lying has other important advantages. The position allows for excellent rest between contractions, which is crucial during a long labor. It is also comfortable and requires no muscular effort to maintain.

One of the most significant benefits of side-lying is its potential to reduce perineal tears. Because the position is gravity-neutral, the baby's descent can be more controlled and gradual. With each contraction, the baby's head advances slightly, and during the rest between contractions, it may slip back a little. This back-and-forth motion allows the vaginal tissues to stretch slowly, reducing the risk of tearing.

If your labor is progressing very quickly, your midwife may suggest lying on your side to slow things down. A very rapid delivery can increase the risk of significant tearing because the tissues do not have time to stretch. Side-lying naturally slows the pace, giving you more control over the delivery.

The position is also helpful when the baby's head pressing against the rectum causes uncomfortable sensations. Many women find that lying on their side reduces this pressure. The position can also relieve pressure on hemorrhoids, which some women develop during pregnancy or labor.

When lying on your side for delivery, you will typically lie on your left side with your upper leg supported, either by your birth partner, a special leg support, or pillows. Keeping the upper leg raised opens the pelvis and allows room for the baby to be born. Your midwife will have good access for monitoring and can support the perineum during delivery.

Side-lying is an excellent position to try if you need rest but do not want to stop labor progress. It is also the position of choice for many midwives when they want to achieve a slow, controlled delivery to protect the perineum.

When Is the Lithotomy Position Used During Birth?

The lithotomy position (lying on your back with legs in stirrups) gives healthcare providers optimal access for monitoring, examinations, and interventions. While not ideal for normal birth, it is commonly used for assisted deliveries with vacuum or forceps, breech births, and when complications arise.

The lithotomy position involves lying on your back with your legs raised and supported in stirrups or leg supports. This position became common in hospitals during the twentieth century because it gives healthcare providers excellent visibility and access for interventions. However, evidence shows it is not the most physiologically favorable position for uncomplicated births.

In the lithotomy position, you are pushing against gravity, which can make the pushing stage longer and more tiring. The position can also compress major blood vessels, potentially reducing blood flow to the baby. Additionally, lying flat on your back can reduce the available space in the pelvis because the sacrum cannot move backward as it does in more upright positions.

Despite these disadvantages, the lithotomy position has important uses. It provides optimal access when interventions are needed, such as assisted delivery with vacuum extraction or forceps. In these situations, the healthcare provider needs to be able to see clearly and maneuver instruments precisely, which the lithotomy position allows.

The position is also commonly used for breech births, where the baby is born bottom-first. The controlled environment of the lithotomy position allows the healthcare team to assist with the delivery of the head, which is the most critical part of a breech birth. Similarly, if there are concerns about the baby's wellbeing that require close monitoring or quick intervention, this position may be preferred.

Your midwife may also ask you to lie on your back temporarily for examinations to check how far your cervix has dilated or to monitor the baby's heart rate. These examinations are typically brief, and you can return to a more comfortable position afterward.

In most modern birth centers and hospitals, women are encouraged to choose their own positions, and the lithotomy position is reserved for situations where it is medically indicated. If you have preferences about which positions you want to avoid, discuss these with your midwife during pregnancy so they can be noted in your birth plan.

How Can Your Birth Team Help with Positioning?

Your midwife and birth partner play crucial roles in helping you use different labor positions effectively. They can suggest positions suited to your situation, provide physical support, help you change positions, and ensure your comfort and safety throughout labor.

Your birth team, including your midwife, nurses, and birth partner, are invaluable resources for finding and maintaining comfortable labor positions. They have experience knowing which positions often help in different situations and can observe how your labor is progressing to make suggestions tailored to your needs.

Your midwife will assess how your labor is progressing and may recommend specific positions based on the baby's position, how quickly labor is advancing, and any challenges you are experiencing. For example, if you are having significant back pain, they might suggest hands-and-knees or standing positions. If labor is progressing very quickly, they might recommend side-lying to allow a more controlled delivery.

Birth partners can provide essential physical support for many labor positions. They can support your weight during squatting, sit behind you on a birth stool, help you walk during early labor, or apply counter-pressure to your lower back during contractions. Having a supportive person who knows what positions you want to try can help you communicate with the medical team even when contractions make it difficult to talk.

Communication with your birth team is essential, especially during positions where they may have difficulty monitoring the baby or providing assistance. If you want to try a position that makes access more challenging, such as squatting or standing during delivery, let your midwife know so they can position themselves appropriately and you can work together effectively.

Before labor begins, consider discussing position preferences with your midwife during prenatal appointments. You can include position preferences in your birth plan. Understanding in advance which positions you might want to try helps your birth team support you effectively when labor begins.