During labor and delivery, adopting various positions—such as standing, squatting, kneeling, or using a birthing stool—can offer several advantages over lying on your back:
1. Facilitates Labor Progression:Â Upright positions, including standing, walking, or using a birthing ball, utilize gravity to assist the baby's descent through the birth canal. This natural aid can lead to a shorter labor by promoting more effective contractions and reducing the need for interventions. Research indicates that staying upright during early and active labor can reduce the need for a cesarean section and decrease the duration of labor.
2. Enhances Pelvic Opening:Â Positions like squatting, kneeling, or lunging can widen the pelvis, creating more space for the baby to move down. This can make the pushing stage more efficient and may reduce the need for interventions. For example, squatting opens the pelvis by approximately 28%, facilitating the baby's descent.Â
3. Improves Comfort and Pain Management:Â Changing positions during labor can help manage pain and make you feel more in control. Some research suggests that certain positions may be useful in moving labor along. For instance, leaning forward during contractions can help the uterus contract more efficiently, aiding in pain management. Additionally, upright positions can stimulate the release of endorphins, the body's natural pain relievers, enhancing comfort during labor.Â
4. Encourages Optimal Fetal Positioning:Â Certain positions can help the baby move into the optimal head-down, facing the mother's back position, which can facilitate a smoother delivery. Positions such as hands and knees or side-lying can encourage the baby to rotate into the ideal position for birth. This optimal positioning can reduce the risk of complications during delivery and may lead to a quicker and less painful birth experience.Â
5. Reduces Back Pain:Â Lying on your back can increase pressure on the back and spine, leading to discomfort. Upright positions can alleviate this pressure and reduce back pain during labor. For example, using a birthing ball allows for gentle movement and can help relieve back pain. Additionally, positions like hands and knees can help relieve back pain by shifting the baby's weight off the spine.
6. Enhances Maternal Satisfaction:Â Allowing the birthing person to choose positions that feel most comfortable can lead to a more positive birth experience. When individuals feel in control and can move freely, it can reduce feelings of anxiety and increase overall satisfaction with the birth process. This sense of control can also contribute to a quicker recovery postpartum. Moreover, a positive birth experience can have long-term benefits for maternal mental health.
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7. Potentially Shortens the Second Stage of Labor:Â Some studies suggest that upright positions during the pushing phase can shorten the duration of the second stage of labor, leading to a quicker delivery. For instance, squatting can increase the pelvic diameter, allowing the baby to descend more rapidly. This can reduce the need for interventions such as forceps or vacuum extraction and may lead to a more straightforward delivery.Â
8. Promotes Effective Contractions:Â Certain positions can help the uterus contract more effectively, which can aid in the progression of labor. For example, leaning forward during contractions can help the uterus contract more efficiently, aiding in pain management. Additionally, positions like hands and knees can help the uterus contract more effectively by allowing the baby to move into a more favorable position.Â
9. Increases Blood Flow:Â Upright positions can improve blood circulation, ensuring that both mother and baby receive adequate oxygen and nutrients during labor. This can contribute to better overall health during the birthing process. Improved circulation can also help in reducing swelling and fatigue. Furthermore, better blood flow can enhance the efficiency of contractions, aiding in the progression of labor.
10. Provides Greater Mobility:Â Being upright and mobile during labor allows the birthing person to change positions as needed, which can help cope with contractions and facilitate the baby's descent. This mobility can also help prevent complications associated with prolonged immobility, such as deep vein thrombosis. Additionally, moving freely can help in finding positions that provide the most comfort and support during labor. This adaptability can lead to a more positive and empowering birth experience.Â
Push Positions With Epidural
While these positions can be beneficial, it's important to discuss your preferences with your healthcare provider to ensure they are safe and appropriate for your specific situation.
With an epidural, you still have several position options for delivering your baby. Although an epidural can limit some mobility, there are ways to still explore different positions to help with labor progression and comfort. Here are some options to consider:
1. Semi-Sitting Position
Description: This position involves sitting up with the back of the bed raised. You may also lean slightly back or forward, depending on comfort.
Benefits: Gravity can assist in the baby’s descent, and this position can reduce the strain on your back and pelvis.
Considerations: The head of the bed will be adjusted to an angle where you can maintain comfort and optimal fetal positioning.
2. Side-Lying Position
Description: Lying on one side with pillows between your knees for added comfort is a great option. This position is often used when you need to rest between contractions.
Benefits: It can help open the pelvis and reduce pressure on the perineum, decreasing the likelihood of tearing. It's especially good if the baby is in a posterior position.
Considerations: This position can be maintained for longer periods of time compared to sitting or standing positions.
3. Hands and Knees Position
Description: Getting on all fours, with knees apart, can be helpful for managing back labor or if the baby is in a posterior position.
Benefits: This position can relieve back pain and help rotate the baby into an optimal position.
Considerations: It may be challenging with an epidural because it may limit your ability to move freely, but it is still possible with assistance or by having a supportive partner or nurse.
4. Squatting Position (with Support)
Description: While squatting may be difficult with an epidural due to lack of mobility, you can use support such as a partner or a birthing bar to assist you.
Benefits: Squatting helps open the pelvis and can encourage the baby to descend. It also uses gravity to aid in the birth process.
Considerations: You will need extra support for balance and to ensure safety, especially with limited leg mobility from the epidural.
5. Supported Standing or Leaning Forward
Description: You can stand and lean forward onto a birthing ball, your partner, or a piece of furniture. This is typically used in early stages of labor or when you’re feeling the urge to push.
Benefits: This position uses gravity to help move the baby down. It can also provide comfort for your back if you feel pain in that area.
Considerations: It may not be as effective if you are unable to maintain an upright position due to the epidural. However, you can still lean on something for support.
6. Reclining/Modified Lithotomy Position
Description: This position involves lying back, with your legs in stirrups or supported by a partner or nurse, to allow gravity to assist in the delivery.
Benefits: It’s often the position used in hospitals and is more comfortable when using an epidural, as it offers full support for your body.
Considerations: While the position is convenient for medical staff, it may not be the most comfortable for some women and does not take full advantage of gravity.
7. Lying on Your Back with Legs Bent (Lithotomy Position)
Description: You’ll lie on your back with your knees bent and feet in stirrups (or supported by someone) during delivery.
Benefits: This is a common position in hospital settings when an epidural is used, as it allows healthcare providers easy access for monitoring and assisting with delivery.
Considerations: It can be less effective for pushing because it doesn't use gravity as efficiently as other positions, and it may feel uncomfortable for some women.
8. Upright or Sitting with Partner or Birthing Ball
Description: You can sit upright, either on a birthing ball or supported by your partner, to allow gravity to help your baby descend.
Benefits: Sitting upright encourages the baby's descent and helps you stay active during the pushing phase.
Considerations: Sitting in a comfortable, supportive way may be challenging with an epidural, depending on the level of numbness you feel.
9. Supported Squatting or Sitting (with Equipment)
Description: If you’re unable to squat on your own, you can use a birthing stool or support from your partner to help with the squat.
Benefits: Squatting helps open the pelvis and can encourage the baby to move down. The stool can give you support if you’re too numb to squat naturally with an epidural.
Considerations: Make sure the birthing stool or support system is secure to avoid any safety issues during delivery.
10. Reclined with One Leg Elevated
Description: In this position, you lie back slightly with one leg elevated on a stool or pillow.
Benefits: The elevated leg can help open the pelvis and ease the process of delivering the baby.
Considerations: You may need assistance to position your leg comfortably due to the limitations of the epidural.
While the epidural limits some movement, healthcare providers can support and help you find the most comfortable position that works with your preferences and the baby’s positioning. Always communicate with your provider about your comfort level and discuss options based on your unique circumstances.
Your pelvic floor physical therapist will help you practice push breathing in various positions to learn what feels comfortable and doable for you. Even with an epidural, you have options!