The American College of Obstetricians and Gynecologists (ACOG) encourages frequent position changes that don’t interfere with maternal and fetal monitoring and that are not contraindicated by complications. In some cases, a baby may respond poorly to certain positions. If that happens, you will need to try something different. For instance, the standard supine (back-lying) position has known adverse effects, like fetal heart deceleration. It’s hard to know how your body or your baby will respond to positions in labor, so trying out a variety of different things is a good idea. Many labor positions can be done with or without the help of your partner, doula, or nurse. During the later stages of labor, you may not feel like walking during contractions. That is perfectly OK. Simply stop and assume a different position or use a standing position for the contractions. You can begin walking again as soon as you feel able. Upright positions, like standing, have been shown to:
Shorten first-stage laborReduce the likelihood of a cesareanResult in fewer abnormal fetal heart rate patternsDecrease the chance that a person will require the use of vacuum or forceps for delivery
Even so, studies have also found some downsides, like an increased risk of perineal tears and blood loss with upright positions. There is no one perfect position. So move frequently and choose positions that feel good and that your baby responds to favorably. You can use any type of chair, from a kitchen chair to a rocking chair. Many hospitals and birth centers have chairs available for you to use in each labor and birth room. You can also sit on a ball. You can also sit in a bed or in a birth tub. If you only have access to a shower, consider sitting on a shower chair in the shower. Sitting backward in a chair can help take some pressure off of your back. It also makes your back available for your partner, doula, or nurse to rub or massage. Studies have found that back massage reduces pain in labor. This is particularly helpful if you are experiencing back labor or if your baby is in occiput posterior (OP) position. This position does not have all the benefits of upright positioning and should not be used for long periods of time. However, it is better than lying flat on your back. It can be used to promote relaxation and has been shown to reduce labor pain. This position may be used in conjunction with epidural anesthesia or other medications. It can also be used to alter positions from semi-sitting. It may be used for laboring people with blood pressure issues or if your baby is showing signs of fetal distress. Squatting may feel good during the first and second stage of labor. However, compared to other positions, multiple studies have found squatting during the second stage of delivery (pushing) to be correlated with increased blood loss. If your baby is in a posterior position or you are experiencing back labor, this position can reduce discomfort. It allows your doula or partner to massage your back or apply counter pressure to help you be more comfortable. If a position ever results in your baby responding unfavorably, such as with heart rate decelerations, move into a different position right away.
Which relaxation techniques and positions enhance the progression of labor?
Walking and other upright positions have been shown to increase the speed of first-stage labor. In fact, one study found that upright positions increased the speed of first-stage labor by one hour and 22 minutes compared to those in recumbent positions.
What positions can you labor in with an epidural?
An epidural doesn’t have to mean that you are confined to lying down throughout labor. There are many positions that are compatible with an epidural. Sitting, leaning forward, side-lying, and hands-and-knees are all good positions to try with an epidural.
