By the time your baby has moved all the way to the second stage of labor, almost nothing feels as good as pushing. It may be intense, but it can feel so satisfying. Each birth is so individual that most of us discover the right position by accident. Knowing in advance which are the effective positions for pushing helps you imagine the ones you think will work for you.
If you plan to walk and move throughout your baby’s birth, be sure to say so in your birth plan. In order to push your baby out in a standing, kneeling, or squatting position, you may not be able to have an epidural. This birth preference should be discussed with your care provider during your prenatal visits, so you are both on the same page.
Because of the high rate of epidural use in the US, about 60% of women labor and give birth in bed, and the effective positions for pushing aren’t available to them. During the second stage of labor—pushing— they’re usually on flat their backs or semi-lying with just their head raised.
Though it’s extremely common, this position works against the progress of labor because it narrows your pelvic outlet (making it difficult for baby to squeeze through) and gravity works against you. Both often cause more pain and longer labors.
But billions of babies have been born from moms in this recumbent/supine position, and it’s the one most of us think of when we imagine giving birth.
Upright pushing positions—why not work with gravity instead?
If you have a walking epidural or no epidural at all and can move around at will, you have a lot of choices for letting gravity help you bring baby out.
Effective positions for pushing while you’re upright include standing, sitting on birthing cushion or chair, kneeling, and squatting.
- 23% less likely to have a forceps or vacuum-assisted delivery
- 21% less likely to have an episiotomy
- 35% more likely to have a second-degree tear*, except when a “birth cushion”is used, in which case there was no additional risk of tearing
- 54% less likely to have abnormal fetal heart rate patterns
- 65% more likely to have blood loss greater than 500 mL**
5 Upright Pushing Positions
Being able to move around during labor means you can stand and walk, which promotes gravity’s help bringing baby down. Standing while pushing can be very effective because baby’s head stays pressed against your cervical opening. Your partner and/or doula can support you by wrapping your arm across their shoulders and helping you stand.
Sitting – birthing chair or cushion
Birthing chairs or cushions come in a variety of materials, designs, and shapes. From simple wood to high-tech swivel, there’s a chair for every person and environment. Birthing chairs or cushions give you the comfort and security of sitting while still being upright so gravity and a fully open birth canal can work with you.
Kneeling really means being on hands and knees. If you’re not kneeling in bed, remember to have pillows under both your hands and knees because you may be there for a while. This position can take the pressure off your back, open your birth canal, and open your lungs. And it’s easy to rock back and forth, opening your hips and working with gravity.
Squatting – Birthing Bar
Whether you’re roaming the room and squatting for contractions, or are sitting in bed with a birthing bar that helps you slide up and squat, this position makes full use of gravity and pelvic openness.
In Otavalo, Ecuador, midwives promote sequential squatting for their laboring mamas. With each contraction, the laboring woman holds onto a bar on the wall for support. As she progresses through labor, she holds onto bars placed lower and lower on the wall. These encourage and support her to squat throughout labor, and help her open naturally and smoothly.
Side, curled position
Although this position minimizes the advantage of gravity, it is still better than lying flat. Increasing amounts of research indicate it may be the best pushing position to prevent tearing.
Though we’re used to seeing women on their backs during labor and birth, there are more effective positions for pushing. With support and encouragement, you can find the position that’s right for you.
Remember to include your final birth plan on your hospital bag checklist — that birth plan will remind your labor team to help you find your best pushing position.
To learn more about birth choices, download our free Birth Plan eBook now. After three years of research, collaboration with more than 100 childbirth experts and resource centers from Healthy Child Healthy World to the American Association of Neonatal Nurses, the Best Ever Baby Birth Plan Guide is available for a free download.
This new resource for pregnant families is a compilation of top tips and advice from more than 20 nationally-recognized experts in the field including renowned pediatrician, Dr. Alan Greene and GraceFull Birthing founder, midwife Elizabeth Bachner. These trusted experts offer thoughtful guidance for whatever type of birthing experience parents want, in whichever setting they choose.
Published: December 26, 2017 | By SP Turgon, Certified Labor Doula | Reviewed by: The Best Ever Baby Expert Team | Last reviewed: December, 2017