• Emily Reul, PT, DPT

Birth Positions

Hi friends! We’ve all seen the women in movies and on TV who deliver their babies while lying on their backs with their feet up in the air. Did you know that isn’t the only position you can deliver in?


You may here this position referred to as dorsal lithotomy or semi-reclined. The legs are often brought towards the chest with the knees allowed to rotate down. These positions can increase the risk of perineal tears, nerve injuries, pelvic organ prolapse, and the need for an instrument (forceps or vacuum) assisted delivery. These can also increase the risk of needing a cesarean delivery due to labor dystocia (when the progression of labor stops), fetal distress, and fatigue of the mother.


However, that’s not to say you can’t deliver in these positions and have a happy, healthy birthing experience. This great interview with Jeanice and Dr. Jennifer Lincoln, MD, IBCLC about birth positions in the hospital from and OBGYN perspective.


Please remember that is for information is for educational purposes only and is not medical advice. It does not replace evaluation and treatment by a licensed healthcare provider.


The best positions for you may be different depending on which stage of labor you are in. The first stage is when contractions begin and your cervix is starting to dilate. When your cervix is fully dilated, you enter the second (pushing) stage of labor.


During the first stage of labor, it can be very helpful to avoid positions of lying down. This allows gravity to help bring the baby down into the pelvis. This may be sitting on something like a stability ball, squatting, or even dancing with your partner. The positions are endless but think of keeping your head above your pelvis. It is recommended to change positions every 15-20 minutes. Staying active can help to keep your labor progressing.


Once you enter the second stage, you may still want to be upright (some individuals deliver standing up!), but your body may be tired and ready to get into the bed. Some common positions for the second stage are on your hands and knees, lying on your side, tall kneeling, or the dorsal lithotomy position. One position isn’t necessarily better than others. It is more important to listen to your body and find what feels comfortable for you. Remember, the pelvic floor muscles need to be able to stretch and relax to allow the baby to come out. If you are uncomfortable, your pelvic floor muscles may be tense and have a harder time letting go.


You may find that equipment helps you to find a comfortable position, too. This can include birth bars, stability balls, peanut balls, or maybe something as simple as rolling up a towel and placing it under your back while lying down.


An epidural may be a part of your birth plan and that’s great. However, once you receive an epidural you will likely be confined to the bed for safety, and you may need assistance switching positions. Having an epidural increases the average length of the second stage of labor (pushing) by about 25 minutes. Studies have shown that the longer an individual is in the pushing stage, the more likely they are to have pelvic floor dysfunction postpartum. But remember, a pelvic floor physical therapist can help address pelvic floor issues.


If you have orthopedic injuries, some positions may be more beneficial (or more comfortable) than others. For example, if you have sacroiliac joint (SIJ) pain you may want to avoid asymmetrical positions (like one foot in front of the other) or a semi-reclined position to allow the sacrum to move freely.


If you experienced pubic symphysis pain or separation during a previous birth, avoiding extreme abduction (legs out to the sides) and avoiding squatting can be helpful.


For those with coccydynia (tailbone pain), avoiding a rounded spine and the dorsal lithotomy or semi-reclined positions can be helpful.


There are so many other conditions like back pain, hip pain, and knee pain that can also affect comfort during labor and delivery. It can be extremely helpful to work with a birth provider either before and/or during labor and delivery. If you are planning to birth at a hospital, check with your provider on visitation rules. Due to the coronavirus pandemic, many facilities are only allowing one support person in the room.


If this is the case, you can meet with a doula or pelvic floor physical therapist who specializes in working with pregnant individuals to find positions that may work for you before you go into labor. In addition, seeing a pelvic floor physical therapist for prenatal visits can help to get your pelvic floor ready to deliver AND help to prevent or treat other pelvic floor disorders like stress incontinence or pain.


Here are some great resources to help improve the birth experience and learn about your pelvic floor:

  • Ask your healthcare provider for a referral to a pelvic therapist.

  • Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.

  • Take our self-paced course Labor and Birth: Preparing the Pelvic Floor with Melissa Dessaulles, PT

  • Watch a interview with Gina from MamasteFit about preparing to push here.

  • Watch an interview with Lynn Schulte, PT on Birth and Healing

  • Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics

  • Sign up for our email newsletter!

  • Watch a quick video to learn about your pelvic floor.


For Healthcare providers, check out our courses to help you treat your pelvic and postpartum clients. You can purchase courses individually, or join our Ambassador Program and most of our courses are included with your membership!


What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.  


Written by Emily Reul, PT, DPT

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