Labor & Delivery Positions

By Dr. Brooke Meinema, DPT, FAFS

When many people envision labor and delivery, they think about someone lying on their back since this is often what is depicted in TV shows and movies. Is this the best position, though? Lying flat on our back with our knees out not only doesn’t allow gravity to help, but it also closes the pelvic outlet and may make delivering more difficult. Allowing for position changes during labor has been shown to reduce complications such as tearing or cesarean sections. That being said, delivery position may depend on the use of analgesia, such as an epidural, and hospital practices. Positions such as standing, kneeling, and squatting take advantage of gravity during the delivery process, but holding one position for a prolonged period of time can be exhausting and require help. Knowing this, allowing rest between contractions and changing between positions can be very helpful. Other positions, such as side-lying, hands-and-knees, and semi-reclined can be a less tiring option while still allowing for greater relaxation of the pelvic muscles and opportunities for rest in between contractions, but they do not utilize gravity to quite the same extent as the previously mentioned positions.

For people who deliver without epidurals, studies are in support of upright labor/delivery positions as they can offer these benefits: “lower the risk of abnormal fetal heart rate patterns, less pain, and less use of vacuum/forceps and episiotomy.” Upright birthing positions may also reduce the time of the second stage of labor.

If you are opting for an epidural, you may still be able to deliver in a different position from flat on your back (once again, depending on hospital policy as well as your help and support). Studies have shown that position changes, even with an epidural, are beneficial to ease of delivery and reduce complications, but you will likely need the help of those around you. One example: evidence has shown a side-lying delivery position can reduce the risk of perineal tearing and reduce the length of active pushing. So even if you are planning on a medicated birth, you still have options and should discuss this with your providers.

Regardless of having an epidural or not, studies have shown greater outcomes with position changes and greater freedom to choose laboring positions the patient is the most comfortable with. For those giving birth, as well as their partner/support person, having an open and honest discussion about delivery goals and plan with your healthcare providers/team is important. This includes discussions about medication use and birthing positions. Remember, you are your own advocate and deserve to have the most comfortable labor and delivery possible.

1^st stage of labor:

• The first stage of labor is when your body is dilating and preparing to deliver the baby. At this point, you are not yet pushing. The contractions will get stronger and more regular as your cervix dilates in preparation.
• Goal: Progress the baby into the pelvic inlet (help the baby descend into your pelvis).
• Focus: Flattening of the lower back, “tucking your tail” underneath you (posterior pelvic tilt), and external rotation of hips (knees turned out).
• To increase comfort:
  • Walk
  • Take a bath
  • Change positions
  • Ask for a massage
  • Remember to breathe!
• Possible positions:
  • With epidural:
    • Upright sitting (with support/assistance).
    • Any other position will depend on the policies in place with your healthcare provider and your ability to move into different positions
  • Without epidural:
    • Standing forward lean with support (partner, bed, birth ball, provider)

• • •   Slow dancing (side to side swaying with support)

• • • Supported kneeling (can lean on ball, provider, partner, etc.)

• • • Forward leaning/Hands and knees (knees turned out)

• • • Other options: Walking, stairs, lunging

2^nd stage of labor:

• The second stage of labor is where you are pushing and delivering the baby
• Goal: Open pelvic outlet for delivery (opening up the pelvis to allow baby to be delivered)
• Focus: Lengthening your spine, can allow your back to arch (anterior pelvic tilt), internal rotation of hips (knees pointing towards each other)
• To increase comfort: change positions as able to with assistance as needed to find your most comfortable position, push when instructed and relax when instructed, and, once again, breathe!
• Possible positions:
  • With (or without) epidural:
    • Side-lying with internal rotation of leg (will need support from partner or providers)

• • • Any other position will depend on the policies in place with your healthcare provider and your ability to move into other positions
  • Without epidural:
    • Lap/stool squatting

• • • Supported squatting (with partner, ball, stool)

• • • Hands and knees/leaning on ball (knees turned in)

• • • Forearms and knees (partner is supplying pressure to sacrum to relieve pressure on back/pelvis)

• • • Kneeling (with partner, bed, or ball)

*Please note: have an open discussion about your delivery goals with your team. Whether it is your support person/partner, doula, midwife, or OBGYN, having a plan in place will help your delivery be safe and smooth!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235063/#:~:text=Birthing%20in%20the%20side%2Dlying,%2C%20%26%20Shorten%2C%202002).

https://evidencebasedbirth.com/evidence-birthing-positions/