Positions During Labor & Birth

Standing

• Takes advantage of gravity during and between contractions
• Makes contractions shorter and more productive
• Helps position the fetus to enter the pelvis
• May speed labor if the woman has been laying down
• May increase the urge to push in the second stage

Walking

Same as standing, plus:

• Causes slight changes in the pelvic joints that encourage rotation and descent

Standing and leaning forward on the partner, the bed, or a birth ball

Same as standing, plus:

• Relieves backache
• Makes it easy for the partner or doula to give a back rub.
• May be more restful than standing upright
• Can be used with an electronic fetal monitor (the mother must stand by the bed unless wireless monitors are used)

Slow-dancing:

The mother leans against her partner, resting her head on his or her chest or shoulder. The partner's arms are under the mother's, around her back, with fingers interlocked at her lock back. She can tuck her thumbs into the partner's waistband or belt loops for comfort. They sway, perhaps to music, and breathe in rhythm.

Same as standing, plus:

• Causes changes in the pelvic joints that encourage rotation and descent
• Being embraced by a loved one increases the mother's sense of well-being
• Rhythm and music add comfort
• Pressure from the partner's hands relieves back pain

Standing lunge:

Standing beside a chair and facing forward, the mother places one foot on the chair seat, with her raised knee and foot turned out. Bending her raised knee and hip, she "lunges" sideways repeatedly during a contraction (either in the direction that is more comfortable, or to the right for two or three contractions, and then to the left). She holds the stretch for two to five seconds at a time. She should feel the stretch in her inner thighs. Secure the chair, and help her keep her balance.

• Widens the side of the pelvis toward which the lunges
• Gives room for the baby to change position, if necessary
• May ease backache after trying this for a few contractions
• Can also be done in a kneeling position

Kneeling lunge:

From starting position a, she bends her raised knee and hip and "lunges" sideways (as in b) repeatedly during a contraction in the direction that is more comfortable, or to the right for 2 or 3 contractions, then to the left for 2 or 3. She holds that stretch for 2 to 5 seconds at a time. She should feel the stretch in her inner thighs.

Same as standing lunge

Sitting Upright

• Gives the mother a rest between contractions
• Uses gravity to help the baby descend
• Can be used with an electronic fetal monitor

Sitting on a toilet or commode

Same as sitting upright, plus:

• May help relax the perineum for effective bearing down

Semisitting

Same as sitting upright, plus:

• Makes a vaginal exam possible
• Easy position to get into on a bed or delivery table

Sitting and rocking in a chair or swaying on a birth ball

Same as sitting upright, plus:

• May speed labor
• Helps relax the mother's trunk and perineum

Sitting, leaning forward with support

Same as sitting upright, plus:

• Relieves backache
• Makes it easy for the partner to give a back rub

Hands-and-knees position

• Helps relieve backache
• Assists the rotation of a baby in OP position
• Allows for pelvic rocking and other body movements
• Takes pressure off hemorrhoids

Kneeling, leaning forward on a chair seat, the raised head of the bed, a birth ball, or the side of a tub

Same as hands and knees, plus:

• Puts less strain on writs and hands
• Relieves back pain very effectively when done in a large tub

Open knee-chest position:

The mother gets on hands and knees, then lowers her chest, spreads her elbows, and rests her head on her hands. Make sure her knees are back far enough to raise her buttocks higher than her chest. You can support her by sitting on a chair, your feet about 9 inches apart. She puts her head between your shins, and leans her shoulders against them.

• May be helpful in pre or early labor
• Uses gravity to move baby's head (or buttocks) out of the pelvis, which may be desireable in early labor if the mother has backache or the baby is OP. Should be done for 30 to 45 minutes.
• May reduce pressure on her cervix, which helps if it is swollen.

Side-lying or semiprone:

In the side-lying position, the mother lies on her side with both knees flexed and a pillow between them (a). In the semiprone position, she straightens her lower leg, rolls slightly toward her front, flexes her top hip and knee, and rests the top knee on one or two pillows (b). During the birthing stage, you can hold the mother's top leg up as she pushes (c).

• Gives the mother some rest
• Makes interventions easy to perform
• Helps lower elevated blood pressure
• Safer than standing or the hands-and-knees position if pain medications are used
• May promote the progress of labor when alternated with walking
• Can slow a very rapid second stage (c)
• Takes pressure off hemorrhoids
• Allows relaxation between pushing efforts
• Shifting between side-lying and semiprone positions, on both sides, helps change the baby's position
• Works well with an epidural

Squatting:

The mother squats on the floor or bed, holding onto your hands (a), a railing, or a squatting bar (b) attached to the bed. Or, if you sit with your feet spread, she may stand between your knees (facing away from you) and lower herself into a squat, with her arms resting on your thighs for support (c).

• May relieve backache
• Uses gravity to help the baby descend
• May aid the baby's rotation
• Widens the pelvic outlet
• Provides the mechanical advantage of the upper trunk pressing on the uterus
• May help bring on the urge to push
• Requires less bearing-down effort
• Allows freedom to shift weight for comfort

Lap Squatting:

Sit on an armless straight chair. The mother sits on your lap facing you, straddling your thighs. Embrace each other. When a contraction begins, spread your thighs, allowing her buttocks to sag between. Have a support person or doula stand behind you and hold the mother's hands for safety. After the contraction, bring your legs together so the mother is sitting up on your thighs again.

Same as squatting, plus:

• Avoids the strain on the mother's knees and ankles
• Allows for more support with less effort for an exhausted mother
• Enhances feelings of well-being, as the mother is held close by a loved one

Dangle with partner:

Hold the mother under her arms as she leans with her back against you during contractions, and bear all her weight. Between contractions, she stands.

Same as squatting, plus:

• Lengthens the mother's trunk, allowing more room for the baby to maneuver into position
• Enhances pelvic joint mobility, allowing the baby to push the pelvic bones as needed to descend
• Uses gravity to help the baby descend

Dangle:

Sit on the edge of a high bed or counter, with each foot supported on a chair and your thighs spread. Standing, the mother backs between your legs and places her flexed arms over your thighs. During contractions she lowers herself. Grip her chest with your thighs as she lowers. You support her full weight. Between contractions, she stands.

Same as dangle with partner, plus:

• Puts much less strain on the partner

On back with legs drawn up:

The mother lies flat on her back and holds her knees apart and draws them to her shoulders. She lowers her legs between contractions. You can help her get into the position with each contraction.

• Should not be used routinely
• Tiring and works against gravity
• May be helpful in prolonged second stage
• Rotates pubic bone upward; may help if baby's head is not descending beneath the pubic bone, by moving pubic bone over the baby's head.