What You Need to Know about Birth Positions

Adriana Lozada:

I’m Adriana Lozada, and you’re listening to Birthful, and this is where I get to talk to you one-on-one about a topic that will make a huge impact in your birth or postpartum process. Today, we’re going to dive deep into positions for labor and birth. So you probably already know that during labor, it’s so important for you to change positions and move your pelvis in different ways, because it can help labor progress by switching up the space available for your baby to wiggle on down and out. However, not all positions are created equally. Some are better when you have back labor or need to increase the intensity of contractions. And also the focus should be more on frequent position changes, then constant movement, because it is as important that you make sure you rest during labor. So we’re going to suss out what you can use when and what to avoid.

Now, this may surprise you, but during early labor, you really just want to go about with your regular life. Making sure you prioritize rest and sleep as much as possible so that you have energy for the long haul. You can go on your regular walks, but early labor is not necessarily the time to be going up and down stairs, doing squats and nonstop moving. If contractions are not demanding your full attention, then a good rule of thumb is to ignore labor as much as you can. And again, make sure you get good rest. Then as contractions get stronger, you’ll want to start switching it up. So let’s talk about what positions are good for what. You may start out using upright positions like walking, slow dancing, and even having a bit of a dance party, if you want. Upright positions use gravity and they create more space than positions where you’re lying down and they also bring on stronger contractions. Upright positions allow for back rubs, for back massage, or someone to apply counter pressure on your tailbone, or even putting a heat pack there.

Now sitting positions let you continue to use the gravity from upright positions, but with the added bonus of helping open your pelvis even more and give your legs a break. You can sit on an exercise ball on a rocking chair on the toilet, you can straddle a chair, you can straddle the toilet or even sit cross-legged. People tend to really like laboring on an exercise ball because the softness of the ball can be easier on the perineum, and also they can do circles or figure eights with their hips while sitting on the ball, so that’s a good one.

So then positions where you lean forward are a favorite, especially if you’re having back pain. In this case, you can lean on your partner or on a table or mix it up with a sitting position. So for example, by sitting on the ball by the hospital bed and then raising the bed so that it’s at a perfect height for you to lean on it while sitting. If you own an exercise ball, you can do something similar at home by kneeling while draping yourself over the ball while on the bed or on the floor. Depending on how you combine the leaning positions they can allow for back massage or counter pressure, use gravity to stimulate contractions, help open the pelvis, allow for good rest between contractions, and as I mentioned, help relieve back pain.

Other great positions for relieving back pain and giving baby more space are, being on your hands and knees, or an open knee chest position where you start at hands and knees and then lower your chest onto some pillows so that your hips are higher than your head. Lunging positions can be fabulous for when things seem a little stuck and baby would benefit from asymmetrical movement of your hips, but really you could do these anytime you feel like it. And I’m not talking about doing wide lunges, but more of supported static ones. So for example, you can put one foot up on a chair at about a 45 degree angle during a contraction, and then your partner can stand in front of you, so you can drape your arms around their neck for more support and stability, and they can rub your back or hips. You see where I’m going with this? You can just layer on comfort measures. Do a few contractions like this, and then remember to do the other side for balance.

You can also create some asymmetrical hip movement by going up and down stairs, which you can do the regular way or facing sideways. Just make sure you hang onto the railing. So then squatting positions can also be great when you want more space in the pelvic outlet. So usually later in labor, as baby is moving through the mid pelvis into the outlet, but if you’re not so used to squatting, they can be really tiring. So a supported way of doing squats is by sitting on a set of stairs and then going down by moving your legs down a step and then scooching your butt down to that step, and then moving our feet again, and so on. Play with the angle of your feet to see how that affects your pelvic opening. Usually if you bring your toes inward, you’ll create more space in your pelvic outlet.

Now for resting, nothing quite beats a side lying position on the bed or in the tub. You can do a more extreme side lying position by bending your top leg way in front of your bottom leg, imagining that your belly button is pointing toward the bed. Use tons of pillows to support your back, support your belly, put some between your legs, and if you happen to have a peanut ball on hand, then those are great for creating a lot of space in your pelvis while supporting your upper leg so that you can sleep in between contractions. There is research that shows that using a peanut ball this way can help speed up dilation, if you have an epidural. And I have seen many a birthing people be able to rest so deeply while in a side lying position that they sleep and even snore between contractions.

And then speaking of epidurals, if you get one, one of the downfalls is that you limit your range of motion. So be even more intentional with your movements and enlist the help of your team to support you into positions that you can’t do on your own, like maybe hands and knees, in which case you can even drape yourself over a peanut ball for support. Tell the anesthesiologist that you want to maximize movement before you get the epidural, so they can give you one that allows for more like control. And if it turns out that you’d like a denser epidural, then it’s easier to go up rather than down.

All right, so then you’ve been laboring and transition and now you get to pushing. First, get rid of that mental picture of having to push on your back with legs on stirrups. In fact, the truth is you’re going to benefit from changing positions during pushing as well, since it can take anything between a few minutes to three hours or more to get your baby out. And especially if it’s taking longer, than your baby may not be in an optimal position yet, so switch it up. You can push in any of the positions that you use for laboring. Some of the favorites tend to be hands and knees, side lying or getting down on one knee. Try to avoid positions where you’re flat on your back or semi-reclining, even though that’s what you see in most of the media and tends to be a preferred position by many providers because these positions can actually make things more difficult for you and for your baby.

For starters, you’ve been told all your pregnancy not to lay on your back. How is that suddenly okay during birth? The reason you avoid this position during pregnancy is to lessen the risk of compressing your aorta, which would impact your baby’s oxygen supply. And then during birth, if you’re pushing in this way, this can create drops in your baby’s fetal heart rate. Also positions where your sacrum is against the bed. So on your back or semi-reclining, they make things harder. The sacrum is moveable, but not if there’s a hard surface on the other side of it, if it can’t have that flexibility, things are going to be more intense. Research shows that the pushing stage is shorter when using a position that allows for a flexible sacrum and MRI studies show that the dimensions of the pelvis become wider when squatting, kneeling or hands and knees, as opposed to lying on your back.

Other reasons why you want to avoid pushing on your back is that it increases the likelihood of using forceps or needing a vacuum-assisted birth of having an episiotomy. And even though it may lessen the risk of having a second degree tear, it increases the chance for a more severe tear, like a third or fourth degree one. The truth is that no birthing person instinctively places themselves on their backs for pushing, that’s like an upside down beetle. That’s really vulnerable and not, no, no, that’s definitely something that’s suggested or ordered by providers and forcing a birthing person into a care providers’ preferred position is in fact obstetric violence.

At the same time though, some people really like pushing on their backs. So the bottom line is connect with your body, get creative, dance, shimmy, sway, move, labor and push however you and your baby want to. 

You can connect with Birthful on Instagram @birthfulpodcast, and to learn more about Birthful and my birth and postpartum preparation classes, go to birthful.com.

Birthful was created by me, Adriana Lozada, and is a production of LWC Studios. The show’s senior producer is Paulina Velasco. Jen Chien is executive editor. Cedric Wilson is our lead producer. Kojin Tashiro is our associate sound designer and mixed this episode. Thank you for listening to and sharing Birthful. And come back next week for more ways to inform your intuition.

CITATION: 

Lozada, Adriana, host. “What You Need to Know about Birth Positions.” Birthful, LWC Studios, December 1, 2021. Birthful.com.