Power Positions: Finding the Best Position for Birth

By Nancy Gottesman

If your car stalled at the bottom of a hill, you certainly wouldn't try to push it uphill. So why does it make sense to fight gravity by lying down during labor? This is just one reason why the standard hospital labor position semi- or fully reclining is not ideal. For one thing, when you're lying on your back, your uterus compresses major blood vessels, potentially depriving the baby of oxygen and making you feel dizzy or queasy. Most women feel better when they are not lying on their back during labor, says certified nurse-midwife Katy Dawley, Ph.D., C.N.M., director of the Institute of Midwifery at Philadelphia University in Pennsylvania. In addition, when you're reclining, the baby's head puts pressure on pelvic nerves in your sacrum, increasing pain during contractions. Remaining upright and leaning forward reduces this pressure while allowing the baby's head to constantly bear down on your cervix. As a result, dilation tends to occur more quickly. Lying on your side, standing, sitting, walking, rocking anything that keeps you active can help decrease pain and speed up labor, says Dawley. Just be aware that a prenatal visit is the time to discuss with your doctor or midwife the different positions you think you'd like to try. In the throes of labor, you're not going to be able to advocate for yourself, she explains.

Seven soothing labor positions:

Here's another reason to be open to the possibilities: Fetal heart monitoring during labor can help determine which positions you can sustain without impairing circulation to the baby, so it's best to have a repertoire available. Some options:

1. Get on all fours - This position eases back pain and helps the baby rotate into the optimal position for delivery face down. (When the baby is face up, the result is the dreaded back labor.)

2. Lean forward - This can help make uterine contractions more effective in bringing the baby down. Drape your chest over a table, bed, counter top, pillow or exercise ball (see Get on the (Birthing) Ball, below).

3. Lie on your left side - This may increase blood flow to your baby and can help reduce back pain. Support your belly and legs with pillows.

4. Lunge - Place one foot on a sturdy chair or footstool and lean into that foot during contractions.

5. Rock - Sit on an exercise ball, the edge of the bed or a chair and gently rock back and forth.

6. Sit and lean - Sitting in a chair, prop up one foot and lean forward into it during contractions.

7. Sway - Put your arms around your partner's neck and sway back and forth; pretend you're slow dancing.

Ready, set, push! While the position may be less convenient for hospital personnel, squatting is especially effective when you're ready to push. In fact, squatting is sometimes called the midwife's forceps because of its ability to work with, not against, gravity, enlarge the pelvic opening and speed the pushing phase of labor. One study found that first-time mothers who squatted while pushing had labors that were 23 minutes shorter on average than women who labored semi-reclining. They also required significantly less oxytocin (Pitocin) to stimulate contractions. What's more, they had less back pressure, fewer forceps or vacuum deliveries, and fewer and less-severe perineal tears and episiotomies. Don't want to squat in the middle of your hospital room? Use the squatting bar on your hospital bed for support. The correct form: knees wide, feet flat on the floor.

Warning: Don't try squatting unsupported unless you're sure you can hold the position and keep your balance. In fact, you should get in shape by practicing squats during your pregnancy: You don't want to find out at the crucial moment that your leg and thigh muscles aren't up to the task. Other options for delivery include sitting on a birthing stool, kneeling or crouching on your hands and knees. No problem if you're having a midwife deliver your baby at home or in a birthing center. Otherwise, make sure in advance that your doctor and hospital policies give you the green light.

Get on the (birthing) ball: Using an exercise ball could help you get through labor. The ideal size for most women is about 65 centimeters in diameter. When you sit on it, your knees should be bent 90 degrees. Here are various ways to use one: Place the ball on a bed or sturdy chair, stand facing it and lean forward so that your upper body rests on the ball. This will enable you to stand up longer without overtaxing your muscles. Kneel in front of the ball and drape your body over it. This will encourage a baby who's faceup to rotate into the proper position for delivery (facedown) and relieve the pain of back labor. Sit upright on the ball. This relieves pain and pressure on your back and perineum (the area between the vagina and rectum).

Tips from a labor nurse: If you're spending even part of your labor in bed, here are suggestions from Fit Pregnancy's Ask the Labor Nurse blogger Jeanne Faulkner, R.N.: Angle the head of the bed 45 degrees and put a pillow or rolled-up towel under one hip; this will help tip the uterus off of your large blood vessels, improving circulation to the baby and your brain. If the baby is faceup and this is causing back labor, lie as far on one side as possible, then rest your top leg on the mattress in front of your belly. This encourages the baby to rotate into the ideal (facedown) position for birth. Changing positions every 10 contractions while you're pushing can help corkscrew the baby out. Start lying on one side, go onto your back, turn to the other side, then get on your hands and knees.