The positions that you choose for labor and birth are important. They can help you be more comfortable during the labor process, and some positions may even help speed up the process of labor.
The American College of Obstetricians and Gynecologists (ACOG) encourages frequent position changes that don't interfere with maternal and fetal monitoring and that are not contraindicated by complications. In some cases, a baby may respond poorly to certain positions. If that happens, you will need to try something different.
For instance, the standard supine (back-lying) position has known adverse effects, like fetal heart deceleration. It's hard to know how your body or your baby will respond to positions in labor, so trying out a variety of different things is a good idea. Many labor positions can be done with or without the help of your partner, doula, or nurse.
1
Walking is a great way to help not only speed up labor but make you more comfortable. It is also a great way to spend early labor. Some people will choose to walk through their neighborhoods, or even the mall on colder days.
No matter where you choose to walk, even if it's simply the halls of the hospital, walking can help your pelvis move about more freely and help gravity assist your baby in moving down into your pelvis.
During the later stages of labor, you may not feel like walking during contractions. That is perfectly OK. Simply stop and assume a different position or use a standing position for the contractions. You can begin walking again as soon as you feel able.
2
Standing can be a great upright position for labor. If you don't feel like walking, but want to be on your feet, standing or swaying while leaning on a chair or support person is a good option.
Upright positions, like standing, have been shown to:
- Shorten first-stage labor
- Reduce the likelihood of a cesarean
- Result in fewer abnormal fetal heart rate patterns
- Decrease the chance that a person will require the use of vacuum or forceps for delivery
Even so, studies have also found some downsides, like an increased risk of perineal tears and blood loss with upright positions. There is no one perfect position. So move frequently and choose positions that feel good and that your baby responds to favorably.
3
Sitting can be a nice position for labor. It allows you to be fully upright and helps gravity to assist you in laboring. It also can help promote relaxation, by allowing you to rest. In addition, sitting is compatible with an epidural and electronic fetal monitoring.
You can use any type of chair, from a kitchen chair to a rocking chair. Many hospitals and birth centers have chairs available for you to use in each labor and birth room. You can also sit on a ball. You can also sit in a bed or in a birth tub. If you only have access to a shower, consider sitting on a shower chair in the shower.
4
Leaning forward can help take the pressure off of your back in labor. You can stand and lean forward over a ball or stack of pillows. You can be on your knees and lean over something or someone. Or you can hang over the side of a labor tub if you have access to a tub while in labor. This often feels like a really relaxing position in labor, particularly between contractions.
Sitting backward in a chair can help take some pressure off of your back. It also makes your back available for your partner, doula, or nurse to rub or massage. Studies have found that back massage reduces pain in labor. This is particularly helpful if you are experiencing back labor or if your baby is in occiput posterior (OP) position.
5
Tailor sitting, or sitting with your knees bent and ankles crossed, is a relaxing variation of sitting. It can be done in bed or on the floor, depending on where you are most comfortable. Again, this is an upright position for labor and allows gravity to help. It is also very relaxing and provides a nice stretch of the inner thigh and back.
Practicing tailor sitting during pregnancy will help it seem familiar and more comfortable and natural in labor.
6
Semi-sitting or semi-reclining is usually done in a bed. It can be used in conjunction with epidural anesthesia or other medications, such as IV medications.
This position does not have all the benefits of upright positioning and should not be used for long periods of time. However, it is better than lying flat on your back. It can be used to promote relaxation and has been shown to reduce labor pain.
7
The side-lying position is a gravity neutral position, meaning that there are no benefits of gravity in this position. Since it is gravity-neutral, it may work to slow down your labor or birth. It can also be used for taking pressure off the perineum and lowering the risk of perineal trauma.
This position may be used in conjunction with epidural anesthesia or other medications. It can also be used to alter positions from semi-sitting. It may be used for laboring people with blood pressure issues or if your baby is showing signs of fetal distress.
8
Squatting is a great way to increase the diameter of your pelvic outlet. This position should not be used until your baby is engaged in your pelvis. This is also known as zero station or lower (positive numbers). Once engaged, squatting is a great position to help encourage the descent of your baby further into your pelvis.
The squatting position is effective in shortening the second stage of labor.
Squatting may feel good during the first and second stage of labor. However, compared to other positions, multiple studies have found squatting during the second stage of delivery (pushing) to be correlated with increased blood loss.
9
Hands and knees is also a gravity-neutral position. It is a great position to help get a break from the intensity of contractions. It is also a helpful position if you have a cervical lip.
If your baby is in a posterior position or you are experiencing back labor, this position can reduce discomfort. It allows your doula or partner to massage your back or apply counter pressure to help you be more comfortable.
10
Lunging involves placing your foot on a chair or footstool and then leaning into the lunge during a contraction. Lunging is an activity that can open the pelvis and offer more room for your baby to move down. It might even help alleviate lower back pain.
Just as there is no prescribed position that is right for everyone or every labor, there is also no pre-determined frequency with which to change positions. During labor, it is important to choose positions that are comfortable and that your baby seems to like.
If a position ever results in your baby responding unfavorably, such as with heart rate decelerations, move into a different position right away.
Walking and other upright positions have been shown to increase the speed of first-stage labor. In fact, one study found that upright positions increased the speed of first-stage labor by one hour and 22 minutes compared to those in recumbent positions.
An epidural doesn't have to mean that you are confined to lying down throughout labor. There are many positions that are compatible with an epidural. Sitting, leaning forward, side-lying, and hands-and-knees are all good positions to try with an epidural.
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