Best Birthing Positions for Every Labor Stage: Tips from Pelvic Floor Physical Therapists

Decimos parto y te imaginas: una mujer reclinada en una cama de hospital, con los pies suspendidos en estribos. Su cara está sudorosa y hace muecas de esfuerzo, y alguien grita "¡empuja!". Es una historia conocida en películas y programas de televisión, y puede que tú mismo la hayas protagonizado.

Pero hay más de una forma de contar una historia, y hay más de una postura para dar a luz. Las investigaciones sugieren que las posturas de parto erguidas (como de pie o en cuclillas) tienen muchos beneficios para la madre y el bebé, y que cambiar de postura a medida que el parto progreso puede ayudarte a controlar mejor el dolor. 

Sigue leyendo para conocer las distintas posturas de parto que puedes probar durante las distintas fases del parto, desde la primera contracción hasta que llegue el momento de empujar y conocer a tu bebé.

Stages of Labor

Labor is a natural process that progresses through three stages. Here’s what to expect in each:

Stage 1: Early and active labor

The first stage of labor is typically the longest and happens in two phases:

• Early labor. During this phase, the opening of your uterus (cervix) starts to thin and open wider (or dilate). Contractions may be mild and irregular at first and then become stronger and more frequent. You may also notice clear, light pink, or slightly bloody discharge, which is a sign your cervix is preparing for labor.

• Active labor. Contractions become stronger and longer and come closer together. You may feel pressure in your lower back and your cervix will dilate faster, from six to 10 centimeters, as the baby starts moving into the birth canal.  

Stage 2: Birth of your baby (time to push!)

The cervix is fully open, or dilated, for delivery (10 centimeters). The second stage of labor is when you begin pushing to help move the baby through the birth canal and into the world.

Stage 3: Delivery of the placenta

Once your baby is out and your healthcare provider cuts the umbilical cord, it’s time for the afterbirth, or delivery of the placenta. The placenta is the organ that provides food and oxygen to your baby during your pregnancy. The placenta may come out on its own or you may need to gently push one more time.

Choosing a Birthing Position

Many people give birth on their backs (called the supine position), partly because they’re not aware of other options. But there are many different birthing positions to choose from. In fact, a growing body of evidence suggests upright positions during labor and birth offer many benefits for mom and baby. An upright position may:  

• Speed up labor

• Help dilate the cervix and widen the pelvic opening

• Encourage the baby’s descent through the birth canal (thanks, gravity)

• Help ease pain

• Increase oxygen supply to the baby

• Reduce the risk of perineal tearing during delivery

You don’t have to stay in one position for your entire labor. Different positions at different stages of labor can help reduce discomfort and ease anxiety and is associated with higher birthing satisfaction.

Everyone’s birth experience is unique and many factors can influence which labor positions will work best for you. 

Sometimes medical reasons play a role. For example, if you need a fetal monitor around your belly to monitor the baby’s heart rate during labor, the device may restrict your movement. If you have epidural anesthesia for pain relief (which numbs your body below the waist), upright birthing positions can be difficult and a side-lying position may work better.

There is no one best position to birth a baby. The key is to find comfortable and safe positions that work for you at every stage of your labor.

Birthing Positions to Try

Here are 10 effective labor and birthing positions recommended for different stages of labor. But you can use any position at any point in the process, if it is safe and comfortable for you. Discuss your preferences with your healthcare provider as part of your birth plan before you go into labor. Practicing some positions before labor can help you be more comfortable using them during labor.

Birthing Positions for Active Labor

Standing and Walking

Walking uses gravity to your favor and can make you feel more in control. This position can also help the baby move into a good birthing position.

• During contractions, lean into a wall, your partner, or a nearby railing or counter.

• As you lean, your partner can press on either side of your hips to help ease pain.

Slow Dancing

This position lets you stay mobile while conserving energy. If you have a partner or birth attendant present, it also lets them play an active role in your labor.

• Wrap your arms around your partner or birth attendant’s neck.

• Slowly sway from side to side.

• During contractions, sway your hips to increase comfort and help the baby descend.

Hands and Knees

This position might be preferable if you are experiencing low back pain.

• Get on your hands and knees with your knees spread wider than your feet (this will help your baby descend).

• Gently rock back and forth or side to side.

• Your partner or birth attendant can apply a warm or cold compress to your spine for relief.

• During contractions, you can drop your buttocks toward your heels (child’s pose).

Rebozo

This position can help ease discomfort in your pelvis or low back and may also help your baby rotate into a more favorable position (especially if your baby is face up).

• While on your hands and knees, have your birthing partner hold a rebozo (woven shawl) or sheet (about five to seven feet long) around your belly.

• Use tiny, gentle, jiggling movements to shift the rebozo or sheet from side to side.

Ball Rocking

This position can promote pelvic opening through relaxed, rhythmic movement.

• Sit on a large exercise ball or birthing ball.

• Rock front to back or side to side.

• Keep your knees lower than your hips to allow room for the baby to rotate.

• You can also kneel in front of the ball and rest your upper body and head on the ball.

• Note: You may need support from a wall, sturdy object, or your birthing partner during contractions.

Backward Sitting

This position can reduce some pressure in your back. It also gives your partner or birth attendant access to rub your back if that provides comfort or pain relief.

• Sit backward on a chair.

• Place one or more pillows between you and the chair and lean forward onto the chair back during contractions.

• You can also try sitting on a toilet to help relax your perineum.

Birthing Positions for Early Pushing

Squatting

This position opens your pelvic inlet (the top of your pelvis) but closes your pelvic outlet (the bottom of your pelvis), making it an effective position during the early phases of pushing. (Squatting during the later phase of pushing may increase your risk of tearing.)

• Sink into a deep squat, using a wall, rebozo, your partner, squatting bar, or a sturdy piece of furniture for support.

• Aim to keep your knees behind your toes.

• You can also try a semi-squat position where one leg is bent and the other is extended straight to your side. (Try both sides to see if one feels better than the other.)

• A supported squat with a birthing stool, yoga block, or a stack of books underneath your pelvis can help support some of your weight and conserve energy.

Lunging

This position will allow your mid pelvis to open. It’s particularly helpful if labor slows down.

• Stand in a side lunge position with one foot propped on a chair, toilet, or stairs. Make sure your elevated foot is at a 90-degree angle from your body (like a Warrior 2 yoga pose).

• Use your partner or healthcare provider for support.

• During contractions, gently lunge into your elevated foot and rock back and forth.

• You can also try a kneeling lunge, with one knee on the floor and the other foot extended forward. Lean your upper body on a birthing ball or a bed for support.

Birthing Positions for Late Pushing

Lying on Your Side

This position is best for later stages of pushing or if you had an epidural. It can help reduce your risk of tearing because it allows your tailbone to open (as opposed to lying on your back).

• Lie on your side with a peanut ball or pillow between your knees.

• Let your partner or birth attendant support your top knee.

• Breathe and rest in this passive position so your uterus can do its job. (If you’re exhausted, your uterus is exhausted too.)

Lying on Your Back or Semi-Reclined

This position can help you conserve energy needed for late pushing. It’s best saved for late pushing since it can restrict pelvic opening.

• You can either elevate the head of the hospital bed so you are more in a seated, upright position or elevate yourself with multiple pillows or a bolster.

• Position a rolled-up towel secured with rubber bands (about three to four inches) under your pelvis to give your sacrum greater mobility.

Birth Positions and Tearing

Questions about tearing during labor and delivery are common: How can I push without tearing? Are there certain birth positions that can help prevent tearing? 

Tearing during birth refers to the tearing or stretching of the vagina or perineum (the area between your vagina and rectum) as the baby passes through the birth canal during delivery. While it’s not always possible to prevent tearing, certain birth positions can help reduce your risk by changing the alignment of your pelvis and allowing your baby to descend more easily. Here are some positions that may help prevent tearing:

1. Side-lying during labor can help alleviate pressure on your perineum and reduce your risk of tearing. This position may also be more comfortable for some people during labor.

2. Birthing stool. Using a birthing stool or squatting bar attached to the bed can help you stay more upright, which may help prevent tearing by promoting better alignment of your pelvis.

3. Hands and knees positions can create a wider pelvic angle, take pressure off your perineum, encourage your baby to descend more gradually, and reduce your risk of tearing.

Your healthcare provider can give guidance on the best positions for your labor and delivery. Staying flexible and open to adjustments during labor can help you find the most comfortable and effective position to reduce your risk of tearing.

Other strategies to reduce the risk and severity of tearing include:

1. Controlled pushing. Push slowly and steadily during contractions to avoid rapid stretching of the perineal tissues.

2. Perineal support. Your doctor or midwife can apply gentle counter pressure against your perineum during pushing to guide the baby’s head and minimize tearing.

3. Warm compresses. Applying warm compresses to the perineum during pushing can help soften tissues, relax muscles, and reduce tearing risk.

4. Perineal massage. Regular massage in the weeks before labor can increase perineal tissue flexibility and lower your tearing risk.

However, tearing during delivery is common. No matter what happens, you can recover from tearing after delivery. Your body will heal on its own over time, and pelvic floor physical therapy, exercises, and lifestyle tips can help you manage any symptoms related to tearing (such as pain or incontinence) as you heal.

Labor Recovery with Pelvic Floor Physical Therapy

Addressing your pelvic floor health is an important part of your recovery, whether you delivered your baby vaginally or by cesarean section. Postpartum pelvic floor physical therapy can help restore core and pelvic floor muscle strength, flexibility, and function. It can be especially helpful for relieving pain and reducing incontinence or other postpartum pelvic floor issues. A pelvic floor physical therapist can help you learn exercises and techniques to enhance pelvic floor coordination, strength, and support, which can speed your healing and improve your postpartum quality of life.

PT Tip: Consistency and Gradual Progression

“Focus on consistency and gradual progression in your exercises,” says Jacquelyn White, PT, DPT, a Hinge Health pelvic floor physical therapist. “Start with gentle, low-impact movements and gradually increase the intensity as your strength and comfort level improves,” she says. Consistent practice provides steady progress without overtaxing healing tissues, she explains.

How Hinge Health Can Help You

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. American College of Obstetricians and Gynecologists. (2019). Approaches to limit intervention during labor and birth. Acog.org. www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth

2. DiFranco, J. T., & Curl, M. (2014). Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body’s Urge to Push. The Journal of Perinatal Education, 23(4), 207–210. doi:10.1891/1058-1243.23.4.207

3. Gupta, J., Sood, A., Hofmeyr, G., & Vogel, J. (2017, May 24). Women’s position for giving birth without epidural anaesthesia. Www.cochrane.org. www.cochrane.org/CD002006/PREG_womens-position-giving-birth-without-epidural-anaesthesia

4. Huang, J., Zang, Y., Ren, L.-H., Li, F.-J., & Lu, H. (2019). A review and comparison of common maternal positions during the second-stage of labor. International Journal of Nursing Sciences, 6(4), 460–467. doi:10.1016/j.ijnss.2019.06.007

5. NIH. (2017, September). What Are the Stages of labor? Http://Www.nichd.nih.gov/. www.nichd.nih.gov/health/topics/labor-delivery/topicinfo/stages

6. Satone, P. D., & Tayade, S. A. (2023). Alternative birthing positions compared to the conventional position in the second stage of labor: A review. Cureus, 15(4). doi:10.7759/cureus.37943