Birthing positions

Midwives are often asked which is the best position for giving birth. There is no one-size-fits-all answer to this question because each birth is different and every woman has their own individual needs. Every mother-to-be should have the opportunity to try out a range of birthing positions and choose the one they feel is most comfortable.

• Birthing positions, depending on the stage of labour
• Birthing positions for early labour
• Birthing positions for active labour
• Ventouse method and caesarean section
• Desire to hold onto something
• Try different positions and remain flexible

Birthing positions, depending on the stage of labour, instinct, and individual situation

There are different positions for early labour, active labour, and the birth itself. Early labour starts when contractions begin to affect the cervix, and lasts until the woman’s cervix is fully dilated at ten centimetres. Active labour is the time from when the cervix is fully dilated until the child has been fully born.

There are two aspects worth noting when it comes to choosing birthing positions. On the one hand, women in labour can intuitively assume positions they find comfortable, as such positions naturally meet their current needs. Then again, there are several postures and positions that are particularly beneficial in certain stages and situations, as they facilitate the baby’s passage through the birth canal. The midwife will take into consideration your individual situation and the baby’s location to make suggestions about which position could be advantageous for the progression of the birth.

Some women instinctively follow their needs and adopt positions that naturally feel right, while others prefer to be advised by the midwife and encouraged to try new positions. In certain situations, it may make more sense to assume a reclining or lying position, for example, if it becomes necessary to reduce the downward pressure. In other stages of the labour it can be useful to adopt an upright position, so that gravity will help your baby move lower down into your pelvis.

Birthing positions for early labour

Walking

Walking is a good way to get labour moving because gravity and movement help to draw the child downwards. Moreover, it can encourage the pelvic floor to open, and speed up the birth. However, walking can also be more challenging as the mother-to-be has to bear her own body weight. She also needs something stable to hold on to during this time.

Sitting on a birthing ball

This is an ideal birthing position during early labour. The woman sits on the ball with her legs apart. She can rotate her pelvis and perform other movements that make her feel more comfortable. She can sit upright on the ball, or bend her upper body forwards and lean on a pillow on the bed. The open and upright posture and the pelvic mobility can have a positive effect on the baby’s progression into the lower part of the pelvis.

Standing

Standing is an active birthing position which enables the woman to press her feet against the floor. She stands on a floor mat and can hold onto a rope or a towel hanging from the ceiling. Gravity helps the baby to move down into the pelvis. This position is suitable during the early and active stages of labour.

Birthing bath tub

Many women find having a warm bath in a birthing bath tub reduces their labour pain and helps them to relax. However, those who need to move and remain mobile may find it restrictive. It is quite possible to alternate between bathing and walking around. Birthing bath tubs are often used during the early stage of labour and some women feel so comfortable in the water that they decide to have a water birth.

We recommend switching between various positions during early labour, in order to shift between active (movement) and passive (relaxation) phases: walking around, lying down, bathing, on all fours, etc. depending on your needs and how the birth is progressing.

Lying on your back on the birthing bed

Very few women opt for this position any more. Lying flat on your back can cause vena cava syndrome: the weight of the baby pressing against the mother’s large vena cava can reduce the mother’s (and therefore also the child’s) blood circulation. This position also doesn’t make use of gravity and is very passive.

Birthing positions for active labour

Sitting on the birthing bed

This is the most common position assumed during active labour. The mother-to-be sits on the bed in an upright position so she can benefit from gravity, yet still relax in between contractions by leaning her upper body against the top part of the bed. Various pillows can also be used for support.

Kneeling

While kneeling, you can take advantage of gravity and have your back massaged. You should kneel on a mat or a pillow. Some women find this position difficult to maintain for long periods of time.

On all fours or elbows and knees position

The woman goes down on all fours (on her hands and knees), or on her elbows and knees. Either on the bed or on a mat on the floor. The woman’s upper body can be supported by raising the top part of the bed and a pillow, or with an exercise ball. This reduces the strain on the spine, so it can be very effective for relieving back pain. This position can also help the baby move down lower into the mother’s pelvis. The pelvis is mobile; it can be rotated and tilted backwards and forwards. Some mothers-to be find this position extremely comfortable, while others feel exposed.

Side-lying position

This position is suitable for women who are planning to have an epidural anaesthesia, or if it is necessary to reduce the pressure on the perineum, or if the woman simply feels comfortable in this position because she is tired. Gravity has less of an effect in this position. The side-lying position is a rather passive, yet relaxed birthing position.

Squatting

The woman squats with her feet on the floor and her knees in the air. In this birthing position, gravity takes affect and the pelvis is widened. It can be strenuous, so it’s good idea for the woman’s partner to sit behind her and help support her.

Ventouse method and caesarean section

If the ventouse method is required, the woman usually switches to a half-sitting position on the bed so that the midwife has the best possible access to the baby’s head. In the case of a caesarean section, the woman is positioned lying down and leaning slightly to the left. Slightly leaning to the left reduces the risk of vena cava syndrome (see above), as this helps to reduce the pressure of the baby’s weight on the mother’s large vena cava.

Desire to hold onto something

Observations of women in labour have shown that many want to hold onto something while giving birth, usually at the end of early labour and during active labour. So it’s important that there are objects available for women to grip and hold on to if they want to. This could be a towel (hanging from the ceiling), a soft rope, pole, handle, a bar attached to the wall or their partner’s hand.

Try different positions and remain flexible

It’s a good idea to try a variety of positions and keep an open mind. Parents-to-be can learn a lot about birthing positions by taking an antenatal course. However, the midwife is also present during the actual birth to provide suitable tips and suggestions for each stage of labour. It’s important to stay open to suggestions and try out new things. What works for you during the birth might be a different position to the one you practised in advance.

Source: Fischer, H. (2003). Atlas der Gebärhaltungen. Hippokrates Verlag, Stuttgart.