Birth positions

Watch enough TV and films and you’d be forgiven for thinking that the only way for a woman to labour is lying flat on her back, knees drawn or up or legs dangling from stirrups. Read our guide to birth positions

But is this really the best way to give birth? We look at some of the positions you may adopt during labour and explain how they could help you achieve an easier birth. 

No doubt the phrase ‘active birth’ has cropped up a number of times since you discovered you were pregnant, but what does it actually mean? Don’t worry – it’s unlikely that your midwife will be asking you if you fancy a spot of badminton while you’re in labour – it simply means maintaining an upright or semi-upright position, in order to make it easier for your baby to descend through the birth canal. After all, when you think about, it can only help to have gravity on your side, so lying flat on your back to give birth doesn’t really make a lot of sense. 

In fact, labouring in a supine (on your back) position is a relatively recent innovation. “Women throughout history, and in all different cultures, have been depicted labouring in upright and gravity-neutral positions,” explains Janet Balaskas, founder of the Active Birth Centre.

“It was only as obstetrics took over from midwifery and birth became more medicalised that women were encouraged to labour on their backs, simply because it made it more convenient for doctors to monitor and examine them.”

Although the one of the main concepts of active birth is that these upright positions are what come naturally to women in labour, Sue Jacob, of the Royal College of Midwives, recommends practicing a variety of positions antenatally, so that you can form an idea of which feels most comfortable for you.

Using a number of positions in labour, rather than limiting yourself to one, will aid the baby in his descent and allow your body to adapt to the various stages of his birth.

Be guided by your midwife, too, as she may suggest changing position to keep things moving. Ultimately, though, just trust your body and your instinct – you’ll find a position that works and feels right for you.

Standing

When to use it: Staying upright allows your baby’s weight to press on your cervix, which in turn helps your cervix to open up, so this is a good position to use in early labour, when women often feel restless anyway.

Try walking around between contractions and resting your body weight on the back of a chair or the wall when a contraction occurs.

What it’s good for: As well as putting pressure on your cervix, walking around, like breathing, will give you something to focus on other than the contractions. “Being on your feet, rather than in bed, also has psychological benefits, as it gives you a sense of being in control,” says Sue Jacob.

“It’s also a position that comes naturally; there’s not such a need to practice it antenatally.”

Why it’s not so good: If your labour is progressing slowly, standing and walking for long periods of time will be exhausting; try alternating between these positions and sitting or kneeling.

Left Lateral

When to use it: During early labour, when your contractions are still quite widely spaced, lying on your left side will enable you to relax and perhaps even get some sleep, saving your energy for the job ahead!

It’s also useful if you need to rest during the exhausting second stage – having your leg raised and supported by your partner will ensure that your midwife still has a good view.

What it’s good for: “Delivering the baby’s head can be controlled beautifully in this position, and there is less likely to be damage to the perineum,” says Sue.

Studies show that lying on your side, rather than your back, does not restrict the flow of blood to the baby, because the weight of your uterus is not pressing on your major blood vessels; it also allows your contractions to continue being effective while being restful for you.

“I gave birth to both of my children lying on my left side,” says Alex, mum to Rosie, three, and Lily, six months. “It wasn’t a conscious decision, it was just where I felt comfortable.”

Why it’s not so good: Lying down may have the effect of making you feel passive; you’re also limiting the amount of help you receive from gravity. The fact that your partner needs to be supporting your leg will mean that they’re restricted in what else they can do for you (ie. massaging your back).

All fours

When to use it: Throughout labour. “In the first stage, I walked around between contractions and then dropped onto all fours over a birthing ball every time a contraction came,” says Sarah, mum to Phoenix, two weeks. “Later, in the pushing stage, I was on all fours almost continuously.”

What it’s good for: Being in this position allows your partner to massage your lower back; it’s also good for back labour (where the baby is in the posterior position, with his back to your back) as it removes the weight of the baby from your spine and provides room for the baby to rotate to the more desirable anterior position (with the baby’s back to your front).

Being on all fours also allows you to rock and tilt your pelvis, relieving pain and assisting the baby in his descent. Because the effects of gravity are quite gentle in this position, it allows for a very controlled delivery of the head and shoulders, with a greatly reduced risk of tearing.

Why it’s not so good: You might find that too much blood rushes to your head in this position, making you feel dizzy and faint; the pressure on your knees, wrists and arms can also be uncomfortable. 

Squatting

When to use it: This position is useful in the second stage when you’re bearing down. Get your partner to support your weight; some hospitals also have ropes suspended from the ceiling for you to ‘hang’ from.

What it’s good for: Squatting has been shown to increase the width of the pelvis, giving the baby more room to move and encouraging his descent, so it’s a good position to adopt of you’ve been pushing for a while without making much progress.

Why it’s not so good: It can be tiring - western women aren’t accustomed to squatting, so our thigh muscles aren’t usually up to the job of adopting this position for long periods of time. “Squatting can be awkward for many women,” agrees Sue.

“It can also make it difficult for your midwife to get a good view of your perineal area.”

Lying on your back/ supine position

When to use it: This position can be used throughout labour but became especially popular for second stage in relatively recent times. “I was on my back in the traditional labour position with both of my babies,” says Louise, 33, mum to Inga-Britt, three and Axel, 18 months.

“Both times the baby crowned unexpectedly, so I didn’t really have time to get into any other position, even if I had wanted to.”

What it’s good for: Because this is the image of labour that we’re used to, many woman may feel more psychologically ‘comfortable’ with it, than with some of the upright positions.

Why it’s not so good: Gravity is not on your side when you’re lying on your back; it’s linked with longer labour and a greater degree of pain, as well as a greater incidence of assisted delivery and/ or episiotomy. Because the weight of your uterus is pressing on your blood vessels, this position can also limit the flow of blood to your baby.

Kneeling

When to use it: Kneeling is useful in the second stage, as it allows you to push down effectively. “I had more or less decided to have my son on all fours,” says Marni, 28, mum to Flynn, two.

“But when it came to it, I felt far more in control on my knees, supported on either side by my husband and one of the midwives.”

What it’s good for:  Kneeling has many of the same benefits as being on all fours, but without the strain on your wrists and arms. It allows you to rock your pelvis, which relieves pain and assists the baby in his descent; it can also help if the baby is pressing against your spine.

“Kneeling has a number of benefits over sitting,” says Sue Jacob. “It takes the pressure off your buttocks and allows a better view.”

Why it’s not so good: The pressure on your knees may quickly become uncomfortable; try kneeling on the bed or on cushions to avoid this.

Sitting

When to use it: Sitting – either straddling a chair or on a birthing ball can be useful in the first stage of labour. When the time comes to push, try sitting on the bed with your knees drawn up; otherwise use a birthing chair or birthing stool.

The toilet is also a good option! “I was encouraged to go to the toilet during second stage,” says Nicolette, mum to Freya, six months. “It was so comfortable I didn’t want to get off; eventually I delivered on a birthing stool.”

What it’s good for: Sitting down has the benefit of familiarity and enables you to rest without losing the effects of gravity, so pressure is removed from your legs and back but maintained on your cervix. Sitting on the toilet is good because we’re conditioned to relax our pelvic floor in this environment; it also relaxes the perineum.

Why it’s not so good: The fact that you are putting pressure on your coccyx (tailbone) means that it is less able to move, which may inhibit the baby’s passage. 

But what about pain relief?

One of the benefits of active birth is that it’s associated with shorter labour and reduced pain – but how will staying mobile during labour impact on your pain relief options?

TENS: The pads attach to your lower back and the current is controlled by a handheld device, so you can move around with ease. 

Gas and air (Entonox): You can still be entirely mobile with this form of pain relief, although it may make you a little light-headed.

Pethidine: Because Pethidine can make you feel quite spaced out and ‘floppy’, your best bet is to adopt the left lateral position, with your leg supported by your birthing partner.

Epidural/ Spinal Anaesthetic: You’ll need to remain in bed if you have an epidural, although some hospitals offer “mobile epidurals” which theoretically allow you to keep moving around.

Water: provided the pool or bath is deep enough, you can adopt kneeling, squatting or all fours positions, while still allowing the water to ease the pain of your contractions.

Breathing and alternative therapies, like massage and aromatherapy: these ‘natural’ forms of pain relief allow you complete freedom of movement in all stages of labour.

Find out More

• For more information about active birth, active birth classes, and to read the Active Birth Manifesto, visit activebirthcentre.com. You can also buy Janet Balaskas’ new book, “New Active Birth” from this site.

• birthchoice.co.uk provides information on where you choose to have your baby and how this may affect your choices in labour

• Visit the Royal College of Midwives website at rcm.org.uk for information about active birth and your midwife’s commitment to supporting your choices in labour

• Lamaze International provides information on the benefits of staying mobile or upright during labour – go to lamaze.org