Labor positions

What are the best positions for labor?

There's no one best position. In fact, most women end up changing positions frequently during labor. Let your body be your guide.

A study analyzed the research on this topic and recommends that women labor in whatever position they find most comfortable. It also suggests that laboring moms not be required to lie down for long periods of time. The study found that women who tended to walk or stay upright during early and active labor shaved about an hour off their labor time and were less likely to have a cesarean delivery.

In early labor, your contractions probably won't require the same attention that they do later on. You may want to putter around the house or take a walk outside. Or, if you're tired, you may want to take a warm bath or lie on your side and try to doze off between contractions.

When labor becomes more active, you can try a variety of positions to help you manage the pain during the increasingly intense contractions. You may choose to be upright at some points and want to recline at others.

(At many hospitals, it's routine to start an IV when a woman is admitted in labor. But if your pregnancy has been normal thus far and no labor complications are expected, you can – with your practitioner's approval – hold off on the IV or ask for a saline lock. That way, you'll be freer to move about as the urge strikes you, without having to contend with tubing and an IV pole.)

One position you don't ever want to stay in is flat on your back. In this position, your uterus compresses the vena cava (the large vein that returns blood from the legs to the heart), which compromises blood flow. Low blood pressure could make your contractions less effective and cause you to feel weak or dizzy.

Labor positions for active labor

Left to her own devices, a woman laboring without pain medication will often assume the position that's best for her without even making a conscious decision. Sometimes, though, the challenge of labor is so overwhelming that it's helpful to have your birthing partner or caregiver suggest various positions and help you get into them.

If you're looking for inspiration, below are some positions that may work for you. If you haven't already done so in childbirth classes, it's a good idea to go over these positions ahead of time with your birthing partner or labor coach.

Standing and walking

Some women like the sense of control they get from standing and walking during active labor. Going up and down stairs sideways will help open your pelvis. During contractions, you can stop to lean against the wall or on your birthing partner.

Rocking or slow dancing

Swaying back and forth in rhythm with your breathing or to music can be comforting during labor. You can do it while standing or leaning on your birthing partner in a sort of slow dance, or by using a rocking chair, if one is available.

Sitting

Sit on the bed or a chair with pillows supporting your back. You can also try to sit leaning forward, which takes some pressure off your back. Or try sitting cross-legged on the bed or floor.

Sitting backward on a chair

Straddle an armless chair (or open toilet seat), facing backward. Place a pillow between the chair back and your belly, and lean into it, resting your arms and head on the top of the chair. This position takes some pressure off your back and makes your back available for your partner to rub or massage, if that appeals to you.

If you've got a plastic or stainless-steel chair or stool, try sitting this way in the shower, letting the warm water pour down your back.

Hands and knees

All fours is a very popular position. Research shows that being on your hands and knees may offer some relief from back pain before and during labor. If you're in this position on a hospital bed and your wrists get tired, raise the head of the bed so you can rest your forearms on it as you kneel. Or lean the front of your body into a stack of pillows.

Sitting upright on an exercise ball

Sit on an inflatable exercise ball (sometimes referred to as a yoga or birthing ball) pumped up enough so that your knees are lower than your hips. Have someone there to spot you if you're feeling shaky. Rolling your hips while sitting on the ball can help move your baby in the right direction.

Sitting forward lean

Sit on the exercise ball and try leaning forward onto a stable surface. This position allows you to stay in a squat and move your hips around while most of your weight is supported. If you have back pain, ask your birthing partner for a back massage.

Standing forward lean

Stand with your feet comfortably wide and drape your upper body over an exercise ball propped on a table. This is a good position for swaying and rocking through contractions, and for encouraging your baby to rotate and descend.

Exercise ball kneel

Kneel on a soft pad or mattress to protect your knees, then lean forward onto a ball, a bed, or your birthing partner's shoulders or lap. This way you can stay upright to keep your labor going while taking some pressure off your back, which is good for everyone but especially those experiencing back pain.

Lying on your side

This position can give an exhausted laboring woman a much-needed break, while avoiding the compression of major blood vessels that may occur when lying on the back. Start by lying on your left side, which is preferable for blood flow. Slide a pillow between your knees for comfort. If you need a change or your baby doesn't seem happy with you in that position, have a support person help you turn onto your right side.

Side-lying lunge

This is a good way to rest while opening your pelvis, particularly if you have an epidural in. Experiment with bringing your knee closer to your belly or higher off the bed by stacking more pillows under your leg.

Standing lunge

Place one foot on a chair, stretching your muscles and ligaments on that side. This can help if your baby's head is tilted to one side or your labor has slowed. Use this position only if it feels good and doesn't cause pain in your pelvis, hips, or knees.

Birth pool kneel

Warm water can ease pain and relieve some of the downward pressure in your pelvis. If your labor has slowed down, try leaning forward in the water to make more space in your pelvis.

Keep in mind that getting in the tub can slow things down if you are still in early labor.

Supported squat

Have your birthing partner hold you under the arms so you can rest in a squat position. Gravity and a wider opening of the pelvis can help your baby to descend.

Be mindful of the blood supply to your lower body in this position. If your legs start to fall asleep, mix it up with hands and knees or side-lying.

Hanging kneel

Hanging may provide the relief you're craving during the second stage of labor. Try putting a yoga mat or pillow under your knees for comfort and rock yourself gently during contractions.

Not all birthing facilities will have straps like the one pictured. Instead, there may be a grab rail on a window sill or a bed rail. You could also try hanging from an open door or your partner's hands. Some birthing beds in hospitals have "squatting bars" that can be attached to the bed, which you can also use later for pushing.

Supported kneel

A supported kneel will open your pelvis wider than sitting or lying down, while allowing your body to be completely supported. If your placenta doesn't come right out after delivery, you can get into this position to encourage a natural third stage of labor.

Labor positions for pushing

Many of the positions you've used throughout labor will also help you during the pushing stage. Again, it's important to listen to your body and change positions whenever the one you're in is no longer working for you.

Many women find that being upright – whether kneeling, sitting, squatting, or even standing – is more comfortable than lying down at this point. Upright positions not only put gravity to work for you, they keep the pressure off of your blood vessels, which may improve oxygen flow to your baby and make your contractions more effective.

Squatting has an added advantage: It slightly increases the diameter of the outlet of your pelvis. This gives your baby more room to maneuver his way through your pelvis and out into the world.

Depending on where you give birth, there may be some options available to help make squatting less difficult:

Use a squatting bar

Squatting bars, which arch over the bed near the foot and are anchored on each side, can be helpful during the pushing stage. When you feel a contraction coming, you can lean forward, grab the bar, and pull yourself into a squatting position. You push until the contraction is over, and then, if you like, lower yourself back down so you can rest between contractions.

Use a birthing stool

A birthing chair or stool has a U-shaped seat that's very close to the ground. It's designed to support your weight while you're in a squatting position. Have your birthing partner stand or kneel right behind you so that you can lean back and rest between contractions.

Sit on a toilet

Try sitting on an open toilet seat. It works much like a birthing stool. (You can stretch a towel between the seat and the bowl for reassurance.)

Hold hands and sit down into a squat

Have your birthing partner stand in front of you, facing you. Hold your partner's hands as you sit down into the squat from standing. That will allow you to use your partner as leverage during the squat, so it's not as difficult to hold the position.

If you must stay in bed or are too tired to hold yourself up, you can be half sitting up with your birthing attendants holding your legs in a squat while you push. Or try pushing while lying on your side: Bend your knees with the bottom leg resting on the bed and your attendant supporting the other leg during contractions. These positions are easier to maintain than a sitting squat and allow you to stretch out your legs between contractions.

Can I try all of these birthing positions?

Not always. Sometimes, a medical or obstetrical condition will dictate what's best for you and your baby.

If you have any complications that require continuous monitoring and you need to stay tethered to a monitor by a cord, your ability to move around will be somewhat limited. You may still try a variety of positions in bed, use the ball, or be able to stand, sit, or pace at the bedside next to the monitor, but you won't be able to take a walk down the hall or sit in the shower.

If you're in this situation, ask if the hospital has telemetry, a wireless technology that transmits your baby's heartbeat to a monitor without a cord being attached. A wireless monitor will allow you a great deal more freedom of movement. And if a waterproof unit is available, you'll even be able to sit in the shower.

You may be offered a Bluetooth-enabled wireless monitor that attaches to your belly, allowing you to move around within a small space and still record the baby's heartbeat. While it won't give you as much freedom for walking as a telemetry unit, it will allow you to change positions frequently, get up to use the bathroom, and push in the positions your body tells you to try.

In some situations, your ability to move around will be limited. For example, if you have preeclampsia, you'll not only need continuous monitoring, you'll also need to remain in bed, spending as much time as possible resting on your left side.

Occasionally a baby's heart rate will indicate that he prefers you to be in one position or another. In fact, one of the first things your provider or labor nurse will do if there's an unwanted change in your baby's heartbeat is to have you move to a different position.

Finally, you'll also need to remain in bed if you're getting systemic medication or are numb from an epidural. However, if you have what's called a "light" or "walking" epidural, you may be able to move around and labor in any position you like.