Birthing Positions: Why Getting Off Your Back Can Make All the Difference
Hey there, mama! Are you having a baby soon? Maybe in the next nine months? Or… in the next couple of weeks?!
Did you know you don’t actually have to lie flat on your back with your feet in stirrups if you don’t want to? Yep - seriously.
Let’s Talk Birthing Positions
Your pelvis? It’s a total rockstar. It’s flexible, it moves, and your body is producing a hormone called Relaxin to help those muscles and ligaments soften and stretch. That means when you change positions during labor, you’re actually shifting the angles of your pelvis to help your baby navigate their grand entrance into the world. Pretty cool, right?
Now, let’s get something straight: upright positions work with gravity, not against it. They allow your uterus to contract more efficiently, reduce pain, and even lessen the likelihood of needing interventions like forceps or vacuum assistance. Plus, they can shorten the second stage of labor. So, yeah, positioning matters.
The (In)Famous Lithotomy Position (Flat on Your Back)
This is the one you’ve seen in every movie, every medical drama - the one where the doctor is front and center like a catcher at the World Series. And while this position is an option and works great for some people, it’s not always the best one.
Pros? It gives your provider a clear view and easy access, which allows them to assist in the birthing process. But the big con is that lying flat reduces the space in your pelvis and puts pressure on your sacrum (which CAN move freely if given the space to do so!). Not to mention, it can also restrict blood flow to you and your baby.
And let’s be real - birthing on your back is not instinctive. If you watch unmedicated births, home births, or births in other cultures, you’ll notice that most people naturally avoid lying flat. Why? Because the birth canal isn’t a straight drop - it’s actually shaped like a J, meaning babies have to move down and then up again when you’re on your back. That’s the opposite of what we want.
Positions That Work For You
Alright, now that we’ve covered the lithotomy position, let’s go over some alternatives that might work better for you and your baby.
Side-Lying
Works with or without an epidural
Fully restful (you don’t have to hold up your own body weight!)
Keeps circulation unrestricted
This position is gold if you want to conserve energy. You can push with both legs bent or just the top leg bent while the bottom stays straight. It also keeps your cervix easily accessible for checks and allows your provider to monitor progress without you having to move much. Win-win.
Kneeling or Squatting
Uses gravity to your advantage
Opens your pelvis up by 1-2 extra centimeters (which is a lot in birth terms!)
Keeps the sacrum flexible
Kneeling over the back of the bed or using a squat bar can feel really natural. If you’re unmedicated, squatting can be powerful, but it’s harder to sustain with an epidural. You can also squat using a birthing stool or even the toilet (yes, really—it’s called the dilation station for a reason!).
A heads-up: squatting can sometimes speed up delivery a lot, which might increase the risk of perineal tearing. But overall, it’s an amazing, effective position.
Tug-of-War Pushing
Helps direct your pushing efforts downward
Engages your back and core muscles
Gives your partner a way to be involved
This one’s fun because you get to pull against a towel or sheet during contractions, helping focus your pushing power where it needs to go. Plus, if your partner holds the other end, it makes them feel more connected to the process.
Standing & Leaning
Uses gravity to keep things moving
Keeps pressure off your blood vessels and back
Allows you to move and sway as needed
Standing (with support from a partner or the bed) gives your baby room to move while keeping you comfortable. A lot of people forget about this one, but in many cultures, it’s one of the most common ways to birth!
The Ultimate MVP: All Fours
Hands down, my all-time favorite position.
Takes pressure off your back and spine
Optimizes blood flow to you and baby
Reduces perineal tearing risk
All fours is a game-changer. It gives your sacrum full mobility, can help rotate babies who are facing a less optimal way, and can make contractions more manageable. Plus, it’s one of the best positions for reducing hemorrhoid pain (bless). You can modify it by leaning over a ball, rocking your hips, or even doing some gentle cat-cow movements between contractions. And guess what? It can be done WITH a well-functioning epidural!
Knees In, Heels Out Pushing (A Game-Changer!)
Most of us think knees out, wide open is the best way to push—but what if I told you tucking your knees in and pointing your heels out can actually widen the bottom of your pelvis, giving baby more room to come through towards the end of childbirth? This is a great adjustment to try if things are feeling stuck, and you can do it in side-lying, all fours, or even with stirrups.
The Bottom Line
You have options. Your body knows what to do, and you have the right to move into whatever position feels good. Whether you’re at home, in a birth center, or in a hospital, you don’t have to stay in one spot—and you definitely don’t have to be flat on your back if you don’t want to be.
Be sure to check out the links below for more research-based birth info, and if you found this helpful, share it with another mama-to-be!
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