The most effective positions in labour are those that allow you to lean forward, use gravity, and open the pelvis. It can be helpful to change positions frequently – every 20 to 30 minutes during labour. This may decrease your pain and help your labour to progress faster.
Often when a mom changes positions, her contractions will feel stronger, as the new position can help the body labour more efficiently. She may need extra support and reassurance as she adjusts to the more intense contractions.
To help the baby move down during the second (pushing) stage of labour, try positions which use gravity, lengthen the torso, relax the pelvic floor and keep the tail bone mobile.
Change positions frequently
Walking and standing
Walking and standing are helpful in the first stage of labour as gravity helps your baby to move down. A backache may also be relieved and your contractions are often more regular. Since standing is tiring, you may find it more restful to lean forward over something or someone.
Sitting upright
Sitting upright in the first and second stage uses gravity to improve your contractions and is a good resting position. However, it can worsen backache and hemorrhoids if you sit up too long. Leaning forward into your partner is a good position – you can have your back rubbed at the same time. Using an exercise/yoga/birth ball to lean over and/or sit on, can help you use movement at the same time you are taking advantage of gravity enhancing positions. As you keep your pelvis moving, you are giving the baby more room to move down and add pressure to your cervix which will actually speed up the labour process. Sitting on the toilet or a birthing stool helps widen the pelvic outlet during bearing down in the second stage when mom is pushing.
If your movement is restricted…
Sometimes a woman needs to stay in bed during labour. Work with your healthcare providers. If you have to stay lying down:
- Ask if you can switch between lying on each side, lying almost on your abdomen, and lying on your back with a tilt
- Make sure you change positions every 20-30 minutes
- Stay lying on your side, not on your back
Kneeling
Kneeling on all fours in the first and second stages is useful for short periods of time. It can take the pressure off hemorrhoids and can relieve backache, especially if you do the pelvic tilt in this position (see Part 1, Exercise).
Lying on your side
Lying on your side in the first and second stages is a good resting position to alternate with walking. You can combine this position with a pelvic tilt to ease contractions, relieve backache and help you relax between contractions. Try pulling your knees up and placing a pillow between them.
Squatting
Squatting in the first and second stage takes advantage of gravity and widens your pelvic opening to help your baby move down. Squatting is not easy so if you plan to use this position during labour, start practicing early in your pregnancy to build up stamina.
| Coping with back labour Back labour is a term used when most of the pain of labour is felt in the lower back. It may occur if your baby is in a posterior position (the back of the baby’s head presses on your lower back or tailbone). You may feel extra pressure on your back during contractions or during the entire labour. |
Most babies in a posterior position will move into a better position before they are born. Using some of the measures described above will help, especially leaning forward and all on all fours positioning and counter pressure where mom is feeling the most pain in her back.
Pushing baby to birth
Once the cervix is fully dilated, the baby can now start to descend into the birth canal (vagina) and through the pelvis to be born! Although the contractions just before this point are usually quite long and very close together, this next stage of labour contractions change to now being ones that now bring the baby to birth! It is very common for women to get a natural break of about 20-30 minutes before active pushing begins. Once mom gets that urge to push, the contractions may be only about a minute long and come anywhere from 4-5 to 8-9 minutes apart, letting mom get lots of rest in between for the hard work of pushing!
Unlike other mammals, the human birth canal is curved, and requires some maneuvering on the part of the baby. The baby enters the birth canal with his or her chin tucked toward its chest. As baby comes down the baby’s face turns toward Mom’s tail bone, and the head tips back as baby comes around the corner. Once the head is born, baby’s head turns back to align with its body for the birth of the shoulders.
It’s interesting to note that if you’re lying on your back, the “corner” turns into a “hill”. You and your baby must both work against gravity to get the baby ‘up the hill’ and out! Also, the ligaments around your pelvis have loosened to allow for more opening, and also to allow the tailbone to act like a “trap door” as the baby’s head moves past. That “trap door” of the tailbone can’t swing open if you’re lying on it! Can you think of other positions that might make the job easier for both of you? You may feel the urge to be in a particular position, or if you’re not sure, your caregivers can help you get into “gravity enhancing” positions that help the baby move through the birth canal with greater ease. Positions that are gravity enhancing can create up to 30% more space in your pelvis. You may also find that changing positions frequently can be helpful.
The 1,2,3,4 and 5 Assessment!
Take this self assessment to help prepare yourself for coping with labour.