Most women in the United States give birth lying on their backs with their hips flexed in what is known as the lithotomy position or in a semi-sitting position. These positions are weight bearing through the sacrum and coccyx (tailbone) and can restrict movement of joints during labour and delivery. Additionally they do not allow for gravity to assist in the descent of the baby through the pelvic outlet.
We encourage pregnant women to explore different birthing positions with their healthcare providers, including upright postures. Even though current literature and obstetric textbooks recognize the potential benefits of upright postures, they are rarely used in traditional hospital settings. Upright postures take the body weight off from the sacrum allowing the pelvis to expand (Edqvist et al. 2016). This may be particularly important for women experiencing pelvic girdle or coccyx pain during their pregnancies. In upright postures, gravity works in favor to help the fetus descend.
As pelvic floor physical therapists, when we consider positioning in labor and birthing, we encourage women to explore the entire range of possible positions. The concept of “freedom of movement” or moving between postures is a great way to:
relieve pain and/or discomfort
promote descent of the baby
improve birth outcomes and reducing
need for epidural
forceps or vacuum assisted birth
perineal tears or episiotomies
unplanned cesarean births
Semi-reclined supported seated position/throne sitting position
Popular Position
In a supported semi-reclining seated position women can get some rest in between contractions and caregivers have clear access to the pelvic outlet. In this position a woman’s legs can be supported symmetrically in an open position which may be helpful for some orthopedic conditions of hip and spine.
Keep in Mind
In a reclined seated posture, woman can be pushing against gravity. The sacrum and coccyx are blocked from fully expanding.
Gravity helps
Sitting more upright and curling the head and trunk forward while pushing can help women use gravity more effectively while pushing.
Not an ideal position for those experiencing:
Back pain
Tailbone pain
Supported squat position
Good position for labor
It both widens the diameter of the pelvic outlet and allows gravity to assist in the descent of the baby.
Women can lean back against a seated birthing partner, lean against a birthing bar, or sit on a birthing stool to achieve this position.
The sacrum and coccyx can expand in this position.
Keep in Mind
Moving into the squatting position can be helpful when the baby is slow to descend.
If the descent of the baby is very rapid there can be tearing of the perineum, therefore sometimes moving out of squat to side lying at the end of the pushing phase can slow the descent down, giving the perineum a chance to elongate.
Supported side-lying
Allows movement of sacrum
It allows for the sacrum and coccyx to move freely to widen the pelvic outlet.
Birthing partner can assist
The birthing partner can help support the upper leg, with hip and knee bent, in a raised position. However, because this position is gravity neutral, gravity will not assist with the descent of the baby. This position can be gentle for giving the perineum time to stretch.
Gravity helps
Sitting more upright and curling the head and trunk forward while pushing can help women use gravity more effectively while pushing.
Quadruped
Comfortable
Many women find being on hands and knees the most comfortable position for both labor and delivery.
Quadruped is a fantastic position for birthing partners to have easy access to massage your back and give gentle counter pressure into your upper hips.
Gravity helps
This position widens the pelvic outlet, allows the sacrum and coccyx to move freely, and allows gravity to assist in the descent of the baby.
Upright kneeling
Comfortable for those that can’t do quadruped
Kneeling and leaning against a chair or over a therapy ball may be more comfortable for a woman who has pain with weight bearing through the arms but still gives similar advantages of quadruped position.
Gravity helps
Women can also move into a ½ kneeling position as well which may help with fetal descent depending on the position of the fetus and/or pelvic asymmetries.
