Positions for labour

What are the best positions for labour?

When your labour starts, you'll probably feel restless and want to move around and keep busy. But this is when it would be useful to conserve your energy before your labour is fully underway. Try to rest and relax for as long as you can. If your labour starts at night, try to get a little more sleep if possible (NHS 2017a), you'll be glad later!

Once the first stage of labour has properly begun, it's best to keep mobile and upright (MIDIRS 2008, NHS 2017a). Research has shown this can make the first stage of labour quicker, and may help you cope with the pain of contractions. It's also better for your baby because his heart rate is likely to be steadier (MIDIRS 2008).

As your contractions get stronger, focus on what’s happening to your body and your baby, and practise your breathing and relaxation exercises.

Now is the time to find the labour positions and movements that help you cope with your contractions.

You could:

• Lean on a wall, work surface or the back of a chair (Tommy's 2019).
• Put your arms round your birth partner's neck or waist, and lean on them (Mayo Clinic 2019).
• Lean on the bed, chair or window sill, using pillows to adjust the height for comfort (Tommy's 2019).
• Kneel on a large cushion or pillow on the floor, holding on to your birth partner or resting on a birth ball (Tommy's 2019).
• Go on to all fours (Mayo Clinic 2019, NHS 2017b, Tommy's 2019).
• Sit astride a chair, resting on a pillow placed across the top (Mayo Clinic 2019, Tommy's 2019).
• Sit on a birth ball and gently sway from side to side or rock backwards and forwards (Mayo Clinic 2019, Tommy's 2019).

You’ll be able to keep moving by shifting your weight from one foot to another, or by rocking your pelvis. Some positions make it easier for your birth partner to massage your back or breathe with you through the contractions.

If you're labouring in the shower, try leaning on the wall, or sitting astride a chair, if your legs are tired (Lawrence et al 2013). Once your labour is progressing well, you may find being immersed in a birth pool makes it easier to move around (Lawrence et al 2013).

Your midwife should encourage and help you to keep moving around and find comfortable positions (NCCWCH 2014, RANZCOG 2017), preferably ones that are upright (MIDIRS 2012, RCM 2012). Your hospital or birth centre is likely to have posters that show positions for you to try.

You may think that you'll be most comfortable lying on the bed, but, keeping as upright as possible may:

• help you cope with your contractions
• increase your chances of a quicker labour
• help you and your baby cope better during labour
• reduce your chances of having a caesarean or an epidural
  (Lawrence et al 2013, MIDIRS 2012)

You may not know which positions will best help you cope with pain and discomfort until you're actually in labour. But practising a variety of upright positions now will help you feel ready when the time comes.

A good antenatal class should give you the opportunity to try out a few different positions, with a teacher on hand to give you further guidance.

Why shouldn't I labour in bed?

If you're upright, gravity can help push your baby's head down on to your cervix to help it open (dilate). This helps your baby's progress through your pelvis.

Lying down in labour may cause:

• more painful contractions, making an epidural more likely (Lawrence et al 2013)
• a longer labour, because contractions may be less effective (Lawrence et al 2013)
• a higher chance of having a caesarean (Lawrence et al 2013)
• a greater likelihood that your baby will need special care after he's born (Lawrence et al 2013)
• a narrower passage through the pelvis for your baby (Reitter et al 2014)

Even so, many women in Australia do give birth while on a bed, although many adopt positions on the bed other than lying down, such as sitting up or kneeling.

How likely you are to move around and try different birthing positions also depends on the facilities that are available to you, and the support you get (Montagu 2013, Nieuwenhuijze et al 2012, Priddis et al 2012).

Some maternity units and birth centres offer mats, beanbags, birth balls, and grab rails or ropes that support you to move around in labour. Ask your midwife or doctor what’s available locally, or when you're touring hospitals, because it could affect where you choose to give birth.

For example, if you'd like to be mobile during labour, but your local hospital, or the hospital your doctor works at doesn't provide facilities to help, you may prefer to give birth at home or in a birth centre instead.

Which positions are best for backache labour?

If you have backache between contractions, as well as during them, your baby may be in a posterior position. Getting the weight of the baby off your spine may help you feel more comfortable. To do this, go on all-fours with pillows under your knees and hands (Guittier et al 2016).

If you find your arms and wrists get tired, or that the blood is rushing to your head, you may be more comfortable if you rest your head, shoulders and forearms on a birth ball, the seat of a chair or your birth partner's lap.

Which positions are best for pushing?

Although many women give birth lying down, research has shown that maintaining an upright position can be more comfortable, may make your labour shorter, and can be better for your baby (ACNM 2012, MIDIRS 2008, NCCWCH 2014).

You may find it helpful to move around throughout labour so you can find the positions most comfortable for you (Gupta et al 2017, NCCWCH 2014).

Experts recommend finding what works for you, but the following upright positions can help with pushing:

• Kneeling and leaning forward, or on all fours, on your hands and knees (MIDIRS 2008).
• Squatting position (can be supported with a cushion or holding on to bars) (ACNM 2012, MIDIRS 2008).
• Sitting position on a birth stool or chair (ACNM 2012, MIDIRS 2008).
• Lying on your side, or in a semi-prone position (similar to the recovery position, but with your lower arm behind your body instead of stretched out in front) (ACNM 2012).

If you’re on the bed, lying on your back is the least helpful position, and may increase your chance of tearing (ACNM 2012). Being upright, propped up with pillows, rather than being on your back, or on your back with your legs in stirrups, will reduce the likelihood of:

• needing help to give birth with instruments
• having an episiotomy
• your baby’s heart rate being affected while you’re pushing
  (Gupta et al 2017)

If your midwife or doctor recommends that you give birth on the bed, or you want to be on the bed, you can still choose to adopt a comfortable upright position. Try kneeling or squatting on the mattress, supported by pillows or your birth partner.

If you’re too tired to be upright, lying on your side is a good option. Similar to upright positions, it provides a wider exit route for your baby through your pelvis (ACNM 2012).

Certain positions for labour are associated with a lower risk of tearing while giving birth. But bear in mind that other factors, such as whether or not you’ve had a baby before and the care you receive, may have more bearing on whether you may tear than the position you’re in (Smith et al 2013).

Should I use a birthing stool?

A birthing chair or stool helps keep you upright while you're pushing. Most maternity units and birth centres have birthing stools along with other equipment to aid your delivery. It’s a good idea to ask your caregiver what’s available at your unit, so you know what to expect.

If you're planning a homebirth, you could consider buying a birthing stool, but they can be quite expensive. Or, you may be able to hire one. Ask your midwife if she knows of anyone locally who might rent stools.

When compared with lying on your back in labour, using a birthing stool reduces your risk of having an episiotomy (Gupta et al 2017).

You may have heard that women who use birthing stools or upright stools are more likely to suffer heavy blood loss after the birth (Gupta et al 2017). This may be because it's easier to collect and measure blood loss when a woman is using a birth stool than when she's lying on her back (Gupta et al 2017). It's unlikely that using a stool or being in an upright position will cause enough blood loss to cause any problems for you or your baby (MIDIRS 2008).

If you use a birth stool, though, get up and move around whenever possible between contractions. This will stop your perineum swelling too much, which could increase your risk of tearing (QH 2018).

Which position is good for not pushing?

When your baby is about to be born, your midwife or doctor may ask you to stop pushing. This is to help your baby be born more slowly, which helps your vagina stretch more gently (Downe and Marshall 2014, NHS 2017a).

It you feel the urge to push at this point, it may help if you change position. Some midwives recommend lying on your left side, with your birth partner supporting your upper leg (Downe and Marshall 2014). Taking some quick breaths, panting through your mouth, may also help you resist the urge to push (NHS 2017a).

What if I have an epidural?

You'll need to stay in bed if the epidural has made you completely numb from the waist down. Your midwife may still encourage you to adopt an upright position (NCCWCH 2014), possibly supported by cushions. The most important thing is to use whatever position you feel comfortable with.

If you have some sensation left and can still move around a little, your midwife may encourage you to keep mobile and as upright as you can (NCCWCH 2014). You may even be able to sit in a chair, with your knees wide apart, and lean forward with every contraction.

If you have a mobile epidural, you may be able to get out of bed and change birthing positions during labour. A mobile epidural is similar to a low-dose epidural. It may give you limited feeling and mobility in your legs, while still providing pain relief (Tidy 2015). It's not commonly available in Australia, though, so ask your midwife or doctor about this option.

Research suggests that having a mobile epidural may make you less likely to need an assisted birth (forceps or ventouse) than a regular epidural. But it's unclear if this is because it may allow you to move around more, or because the drugs used are slightly different (Wilson et al 2009).

More on preparing for labour:

• Have you written your birth plan yet?
• Discover how breathing exercises can help you cope with contractions.
• Find out whether hypnobirthing techniques can really help you have an easier birth.
• See our expert advice on what to pack in your hospital bag.