Birthing Positions 101

Dr. Hannah Lattanzio, PT, DPT

Birthing positions refer to the various poses or postures one can assume for labor and delivery. While having a baby is certainly hard work, the position a person delivers does have an impact on the ease of delivery. 

Introduction

Current statistics show that most people in western countries (68%) deliver in supine position followed by semi-sitting (23%), upright (4%), side-lying (3%), and hands and knees (1%). 

Compared to a supine position (laying down on back), research shows upright positions (squatting, standing, kneeling, etc.) have an advantageous shorter second stage of labor. This is because the descent of the fetus is aided by gravity, the pelvic outlet is widened, and the need for c-sections, episiotomies and assisted deliveries is decreased. 

According to recommendations by the World Health Organization, an opportunity should be given to the pregnant person to choose the position(s) they would like to deliver in, and that changing positions during labor is thought to reduce pain and discomfort. 

As you continue to read through this post, it is important to remember the best position is the one that you choose and feel most comfortable with. 

Now that we covered the basics, the second most common question I get is “what are my options?” Check out the list below with brief descriptions to learn about the various positions available to you. 

Position Options

Below is a list of different positions you can assume in labor (per your OBGYN, midwife or healthcare team guidelines). 

• Lithotomy: lying on the back with knees bent and positioned above the hips and spread apart with the stirrups

• Lateral or sidelying: include the pure side-lying and exaggerated Sims position. 

  • Pure side-lying posture: lying on side hips and knees flexed. 

  • Exaggerated Sims position: lying on side with lower arm behind (or in front of) the trunk, lower leg extended, and upper hip and knee flexed 90 degrees or more.

• Squatting: the feet carry the majority of her weight but knees are visibly bent. Maintaining the squatting position for a longer period of time may be difficult for pregnant people and, thus, is considered to be one of the major drawbacks. 

• Others: kneeling, quadruped (hands-and-knees), and standing 

• Equipment: birthing stool, birthing bar, peanut ball, and exercise ball 

Outcomes

Various outcomes and their correlated positions have been studied. These include: maternal health and comfort, perineal tearing and trauma, extent of medical interventions and stages of labor. Below is a list of positions found in research to improve or reduce: 

• First stage of labor: upright positions 

  • No difference in upright positions vs. supine or recumbent variations when epidural is used 

• Second stage of labor: sitting, standing, kneeling and/or squatting

  • With epidural the second stage of labor may be prolonged in these upright positions

• Pelvic floor trauma/perineal tearing: sidelying

  • Squatting has been found to have a slight increase in tearing, however not statistically significant

• Need for medical interventions: standing, kneeling, squatting or sitting 

• Maternal comfort: not position-dependent, is influenced by amount of control and autonomy 

Other unmodifiable factors such as parity (how many children one has delivered), healthcare team preferences and experience, maternal and fetal weight, maternal age, and whether an epidural was given may influence outcomes. 

Final Thoughts

At the end of the day, there is no wrong position to deliver in as long as you feel in control and confident in your own body. ​​There are several different positions for each stage of labor and you may also use props, such as a yoga ball or a birthing bar. Utilize the positions that feel best in the moment. Moving around and trying out a variety of different positions can help progress labor and manage pain. It is worth remembering that certain birthing positions may not be plausible, depending on your individual circumstances, such as whether you or baby need to be monitored, if you have an epidural, etc. 

It is a common misconception that one should go to pelvic floor physical therapy after delivery.  However we recommend establishing care with a pelvic PT during pregnancy to learn how to push and what birthing positions feel best for you while remaining safe and effective. 

Still have questions? Please contact us for more information!