Labor and Birthing Positions for a Comfortable Delivery

Pregnancy is a time for making many decisions, including whether to see an obstetrician or midwife, where to give birth, who should be present when baby is born, whether or not to hire a doula, and how long to take off of work for maternity leave. 


One thing that is often left out of pregnancy decision-making is choosing which birthing positions to use during labor and delivery. The most popular birthing position in the U.S. is the semi-sitting, or lithotomy position. This position has become popular over time because it facilitates labor and delivery interventions, such as forceps or placement of a vacuum. 

However, there are a myriad of other birthing and delivery positions, all of which have their own pros and cons. These include the following:

The upright birthing positions:

  • Walking – This is typically used during early labor, prior to full dilation of the cervix. 
  • Sitting – This can be done on a birthing ball, birthing chair or stool, or on a toilet seat. The benefits of the sitting position are that it helps to ease the pain of contractions, can widen the pelvic opening, and facilitates relaxation of the pelvic floor muscles and perineal area.
  • Squatting – Like sitting, squatting opens the pelvis and uses gravity to assist with baby’s birth. Women who choose to squat need to make sure to have someone (or something) to hold onto so that they do not fall over. This can be a partner, doula, birthing bar, or bedpost. Women can also stand with their backs against the wall for support during squatting.
  • Semi-sitting (lithotomy) – As mentioned earlier, this is the position used in most hospital deliveries in the U.S. The head of the hospital bed is elevated to 30-45 degrees and having a pillow placed under the right hip can improve blood flow from mom to baby while pushing in this position.

The lying down birthing positions:

  • Side-lying – This is a good position to use for rest after spending time in a more upright position, like squatting. Side-lying is sometimes used after an epidural has been placed to improve placental blood flow and oxygen delivery from mom to baby. 
  • Lying flat on back with legs elevated in stirrups (dorsal lithotomy) – This position is rarely used anymore as it can interfere with placental blood flow and is associated with an increased risk of perineal tearing.

The hands and knees/kneeling birthing positions:

  • Hands and knees (getting on all fours) – Benefits of being on one’s hands and knees are that it opens the pelvis and takes advantage of gravity. This position can also be used to help ease the pain and discomfort of back labor. Medical professionals will sometimes recommend changing to an “all fours” position if there are any concerns about a baby’s heart rate during labor, as it improves blood flow from mom to baby. This position can be done on the floor, using some sort of padding for comfort, like a yoga mat. It can also be done in bed or on a mattress on the floor.
  • Leaning over while kneeling – Leaning over can take pressure off of the back by helping baby’s head to move forward. This position can be accomplished by leaning over your partner or doula’s shoulders, a chair, a stack of pillows, and/or a birthing ball. 

Tools and props used to facilitate birthing positions:

  1. Birthing ball: Also known as an exercise ball. During early labor, many women find some pain relief by sitting on a birthing ball and gently rocking in all directions. Using a birthing ball is also a wonderful way to be able to explore different positions to labor in. Women can sit on birthing balls during labor, kneel or lean over a birthing ball, and use it as support when in the squatting position. Birthing balls come in 3 sizes, so it’s recommended to choose one ahead of time to make sure that it’s the right height and diameter for you.
  2. Peanut ball: A ball-shaped like a peanut that can be used to help to get into optimal positions during labor. Women with epidurals can really benefit from using a peanut ball as resting it between one’s legs while side-lying in bed can open up the pelvis and provide comfort.
  3. Birthing bar: A metal or plastic bar that attaches to a labor and delivery bed. A birthing bar can be added at any point during labor and used in a variety of positions, including semi-sitting and leaning over. It can also provide stability while squatting or kneeling.
  4. Birthing stool or chair: A chair or stool (chair without a back) that mothers can sit on to facilitate pushing. Sitting on a chair during labor helps to use the same muscles to push as are used during a bowel movement.
  5. Pillows: It’s wise to have several pillows on hand to squeeze, lean over, elevate your hips, and/or place between your legs to facilitate certain birthing positions. 

FAQs about labor and birthing positions:

Is it okay to change birth positions? 

Yes, you can and should try out different positions during labor until you find the one(s) that work best for you. For some women, this means changing positions every few hours and for others, this might need to be done every few minutes. It’s not unusual for women to change positions when going from early labor to active labor as well. For example, being upright and walking around might make sense during the first stage of labor, but not during the second stage of labor when you are having frequent strong contractions and need to focus on pushing.


What are the stages of labor?

  1. First stage: During this stage, contractions cause the cervix to fully dilate. During early labor, which can last from hours to days, the cervix dilates from 0 to 6cm. In active labor, stronger contractions occur 3 to 5 minutes apart and each one lasts for about 60-90 seconds. The cervix goes from 6cm to fully dilated during the active labor phase.
  2. Second stage: The second stage, or pushing stage, starts when the cervix is fully dilated and ends with the birth of the baby. This stage usually lasts between 1-3 hours and is when women experience the strongest and most painful contractions.
  3. Third stage: Delivery of the placenta occurs.

What birth positions can you use after you get an epidural? 

An epidural is anesthesia that is injected into the lower back to numb the bottom half of the body and decrease the labor pain. It provides a continuous dose of anesthesia and the amount of medication administered can be adjusted up and down based on pain. After you get an epidural you need to be continuously monitored and a bladder catheter needs to be placed to prevent urinary retention. The ability to move around and change positions at all after getting an epidural will depend on the facility you are delivering at. The birthing positions that are most often recommended for those who have epidurals include side-lying (especially lying on one’s left side with a peanut ball between the knees), sitting, and semi-sitting.


What positions are best if you are experiencing “back labor?”

“Back labor” describes when laboring women feel back pain in the lower back both during contractions and between contractions. Being able to move around and change positions frequently can help with pain from back labor. Sitting and rocking around on a birthing ball can help during early back labor, while kneeling, leaning over, and the hands and knees position can be especially helpful during the pushing phase. 


Do certain birth positions shorten labor?

There is some evidence that using upright labor positions, such as squatting, may shorten the duration of labor, and that the dorsal lithotomy position is associated with longer labor. The downside of the standing positions is that there is an association with an increased risk of bleeding and damage to the tissues of the perineum in some studies. Although the side-lying position has not been shown to shorten labor, it is associated with less bleeding and tissue damage than other positions. 


Can changing birth positions help to prevent needing a c-section?

To my knowledge, there is not a clear answer to this question. There are studies showing that women who labor in upright positions may have a decreased risk of needing a cesarean but other studies point to an increased risk of needing a c-section with squatting.


Are certain birthing positions better than other positions? What do the “experts” have to say about birth positions?

There’s very conflicting information about which birthing positions are the “best,” as position choices and options need to be individualized. Thus, it’s recommended that birthing mothers be able to try out multiple positions to try the best positions that work for them. Optimal labor and delivery positions can vary greatly from woman to woman and can also vary for each woman’s different deliveries. The most important thing is for laboring mothers to be able to give input into what positions they can try out and explore, and to be able to speak up if a certain position is not working for them while giving birth.


About the Author

Jessica Madden, MD, is the Medical Director at Aeroflow BreastpumpsDr. Madden has been a board-certified pediatrician and neonatologist for over 15 years. She's currently on staff in the neonatal intensive care unit (NICU) at Rainbow Babies and Children’s Hospital in Cleveland, OH. She previously worked in the Boston and Cleveland Clinic Children’s Hospitals. In 2018 she started Primrose Newborn Care to provide in-home newborn medicine and lactation support. She also enjoys traveling, yoga, reading, and spending time with her children.

Information provided in blogs should not be used as a substitute for medical care or consultation.

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