For most of human history, women were free to move about during labour. They were able to adopt upright positions that felt comfortable and eased the pain of contractions.
It wasn’t until the 1700s that lying down to give birth became the norm, thanks to obstetricians who wanted easier access for examinations. They also found it more convenient to perform procedures such as episiotomies or forceps deliveries.
Birth moved from home into hospital during the 1900s. The medical model of maternity care became entrenched in society, along with the expectation that women would labour on a bed. Flat on their back, and sometimes with their legs in stirrups. There was a complete lack of evidence to support this physiologically dysfunctional birthing position, which simply came down to doctor preference, and subsequently, how they were then trained.
However, there are plenty of reasons NOT to lie down while in labour, which is fully backed by evidence.
Giving Birth Upright – 9 Big Benefits
The significant advantages of giving birth upright are:
#1: Allows Gravity To Assist Baby’s Descent
Why work harder than you need to? Your uterus contracts out — or forward — from your body. When you’re upright, you can work with gravity and your body’s natural functions in labour. When you’re lying down, you’re bearing the brunt of weight and force, which is going against gravity.
#2: Fewer Interventions
When you’re giving birth upright, making use of gravity and more effectively using your muscles, you’re less likely to need interventions such as forceps or episiotomies. When you’re working against gravity in dysfunctional position, both you and your baby are more likely to need help.
#3: More Efficient Contractions
When you’re upright, leaning forward and working with gravity, your contractions will become much more efficient. If you’re lying on your back, your uterus will be contracting upwards, which is not working with your body, but against it.
#4: Less Pain
When you’re off your back, you’ll experience less pain than you will giving birth lying down. This is because you have all the weight on your back and you’re working against gravity.
#5: Shorter Labour
When you’re working with gravity, in a position that your body and baby is designed to work well, your labour will likely be much shorter. Although, it probably would be closer to “normal” — because lying down may slow your labour down.
#6: Better Oxygen Transfer To Your Baby
When you’re lying on your back, you’re bearing the full weight of the baby, your uterus, placenta and all that comes with it. Doing so puts pressure on important blood supplies in your own body. Compressing the blood supply also compresses the oxygen supply to your baby. By being upright, you’ll provide a better oxygen and blood supply to your baby. In turn, this means that your baby will be less likely to experience fetal distress. Fetal distress that cannot be rectified quickly usually results in a caesarean section.
#7: Mothers Overall Satisfaction Increases
Studies have shown that by giving birth upright, a mother’s overall satisfaction of her birth increases. And that’s no surprise given what we’ve already learnt – that an upright labour can result in a less painful labour, with less intervention likely, and so much more.
#8: Significantly Increases Pelvic Space
Lying down reduces pelvic diameter about 30%. Especially if you have concerns about having a big baby (which you shouldn’t be, because your body is cleverly designed to birth!), lying down is not going to help your body open as well as it could. Being upright opens up your pelvis, whereas lying down closes it up. This is why scans are inaccurate in diagnosing your pelvis’ ability to birth your baby.
#9: Lying Down Forces The Mother To Push “Uphill”
Pushing “uphill” against gravity can be ineffective and exhausting. Getting upright means you’re pushing “downhill” instead.
Giving Birth Upright – 5 Position Suggestions
Now you know why giving birth upright is much more beneficial to mother and baby — so, what sort of positions are best?
Here are five birth positions that can promote effective contractions and an easier labour. Each of these positions can be used in the first and second stages of labour. Some positions may require the support of your partner, doula or midwife. It’s important to remember that you are the deciding factor in what is comfortable and works best for you.
Upright Position #1: Standing
Gravity works best in this position. Baby’s head is able to apply even and direct pressure onto the cervix, helping dilation. Contractions strengthen and become regular. In this position, the labouring mother can hold onto her birth support partner, rock and sway, lean against walls and so on. Slowly walking/swaying is a variation of this position.
Upright Position #2: Hands and Knees/Leaning Forward
Many women instinctively adopt the hands and knees position when in the later stages of first stage and pushing stage. This position is very adaptable and can include leaning forward over a birth ball or pile of cushions, or any handy piece of furniture like a table or bed. It allows for a full range of movement in your hips, such as rocking and swaying, which can increase comfort.
This position is also favoured by women who have back labour pain due to a posterior baby (baby is facing frontwards or his back against your back). Hands and knees positioning during posterior labour can help reduce back pain and promote baby’s head turning into a more favourable position.
Upright Position #3: Squatting
Squatting doesn’t come naturally to women in Western cultures but it is a very powerful position to use when pushing. It’s a good idea to practice squatting during your pregnancy. Make sure you build up slowly, to avoid injuring yourself as well as getting your muscles familiar with the position. It’s not easy to balance when you have a bump out the front, so using a wall or holding onto a doorknob can provide you with the support you need.
Squatting opens the pelvis and increases the space for baby, while allowing gravity to help baby move down without much effort.
Upright Position #4: Sitting
Some women find a lot of comfort and relief in sitting on a birth ball during labour. It allows them to rock and sway through the contractions. Sitting allows you to plant your feet wide apart and open up your hips, as well as taking pressure off your legs. Straddling a chair and using the back as support, or even sitting on your partner’s lap and leaning forward can be very comforting. The toilet can be a great place to be during labour, as it is a place where we feel comfortable releasing and letting go, which can help you to release and relax your pelvic floor muscles.
Upright Position #5: Lying Sideways
If you have had a long labour, being able to rest without discomfort is important. Side lying allows you to relax your body without increasing pressure on major blood vessels, which can compromise blood flow to your baby. If you have had an epidural or need constant fetal monitoring, lying on your left side can give you the benefits of an upright position. A fast birth can also benefit from side lying (or hands and knees), as it can help slow things down. It can also be a fantastic position to push baby out, particularly if you are tired and would need support being upright.
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I delivered both of my boys on my hands and knees. First birth with my body tilted down and my face buried on the floor in a pillow and by butt in the air. Second birth with my body tilted up and forward leaning on my husband. This article offers several positions for women to try out but my midwife has always said that when allowed to move around in labor, women instinctively go into the position that is best for her. I never even considered the posibilty of trying to stand or squat or use any other position. I immediately just got on my hands and knees and stayed there until the baby was out. I guess whatever orientation my baby had and pelvic shape I have, the hands and knees position was the most efficient.
I delivered both my children on my back, and the pain was unbearable and I thought I would die. This is good information to pass on
Thank you for posting this article. It and all the comments are very encouraging, which is important when you live in a society that treats pregnancy as if it were a sickness requiring constant probing of you and your baby. I find the frequent, even weekly at times, recommended prenatal visits ridiculous. …the med profession has perpetuated a mindset of not trusting our own bodies. Our bodies can grow a human, how amazing but we are doped in thinking we need someone to poke our belly and take harmful ultrasounds in order to have a “safe” pregnancy, as if our body isn’t intelligent enough to let us know if something is wrong.
I had my first child in 1971 and it was a very upsetting situation. I had 23 hours of labor and my baby was born by C-section.
While in labour I was made to lay on one side, I wasnot allowed to lay on my back and not allowed out of bed.
The standing and being allowed to move around would have probably been much better positive to be in.
Great post.
When the women weren’t directed by midwives or obstetricians, and the environment facilitated their moving about adopting different positions, the majority gave birth upright and forwards leaning – the total opposite to what happens when a woman gives birth on her back on a bed.
I wasnt given a choice or proper support when I had my first & he was posterior with a lot of intervention & the longest most painful birth on my back (14+ hours). My daughter also on my back but thank goodness she was smaller & the birth was faster (2+ hours). The next 4 I birthed standing which I have found to not only be less traumatising but gravity has played a major role with the speed of the delivery & the natural assistance with baby’s descent, my last baby weighing 11.2 pounds. Im 28 weeks pregnant with my 7th & intend on birthing standing. All natural, no drugs with a very speedy recovery except for that first birth.
I gave birth with both my younger boys standing up, i found labour far easier, faster, and felt more in control, i needed less pain relief, less stitches. With my first son i was made to lay down in labour and almost ended up with a csection, labour was agony and had an epidural but it was still painful. Definitely recommend staying upright for labour
I birthed my 5th in the shower, standing. My largest baby and by far the most simple and quick.
When I had my first, the midwives wanted to check me to make sure I was indeed in labor and dilating. I couldn’t BELIEVE how much it hurt to lay on my back. During the check, I had to take breaks to roll to my side during contractions because of how unnaturally intense and uncomfortable it was. Never have I had the urge to lay on my back during natural labors. I always want to be sitting up or standing. In fact, I gave birth to my third while standing up in a slight squat. My midwife encouraged me to try the squatting stool which I gave up on after a few pushes. Since I was down on the floor I figured I would try some other positions in case they “clicked” and felt right, but nothing felt the same as standing. So that was what I did, and I didn’t push for more than 15 minutes. Not bad! 🙂
So, where are the study references and evidence you talk about?
Gravity works in the vertical plane. If you’re lying down you’d be working without gravity but I don’t think you’d be working against it.
Joseph, there’s a hyperlink (“evidence”) right in the article–it links to a Cochrane review.
The first birth I ever attended as a friend support person was a home birth. My friend squatted holding on to a bed post or walked through most of the labor and delivered in the bed that way. It seemed natural.
I was pregnant and had a hospital birth so radically different (1980) that I have been a home birth supporter ever since.
As a souls I always hope to support your veiws in this article if mom and midwife of are a like mind.
Thank you.
baby number one is due Saturday! I have plans to try all of these positions as to avoid laying on my back as much as possible. Thanks for the helpful information!
I had my daughter standing and it was nice and fast 20 minute labour. Only problem she had chord around her neck and doctor had trouble releasing it. Thankfully gravity took over and she arrived swiftly with minor complications.
This is awesome info. I’m due in the summer with my third baby but I’m hoping this time to have a natural birth
I had my 2nd daughter in 15mins, & I think it was because I stayed standing, I held onto my partner & the wall for support, it was so easy & a lot less pain.
Did you have a natural birth?
While in Vietnam as a Marine Tunnel Rat I saw 2 women, at different times and in different villages giving birth. They were standing holding on to a branch above them, with 2 women with a basket between their feet and the babies came right out. Not a sound at all from the mothers. Standing is the best way to give birth.