When many people picture labor and delivery, they imagine someone lying flat on their back with their legs up. This is a common image in movies and in birth settings, but it is not the only way to labor or give birth. For many people, being able to move, change positions, and choose a position that feels comfortable can make a meaningful difference in the birth experience.
Different positions can change how pressure is distributed through the pelvis, help you manage contractions, and give you options for rest. Upright positions may also help labor progress during the first stage. However, there is no single position that is best for everyone, and research does not show that one position reliably prevents tearing or guarantees a faster delivery.
Your options may depend on your baby's position, how labor is progressing, whether you have an epidural, your mobility, monitoring needs, and your hospital or birth center's policies. The goal is not to force your body into a particular position. It is to have options and feel supported as you find what works best for you.
A quick note about the stages of labor
The first stage of labor is when the cervix dilates and the baby moves down into the pelvis. During this stage, you are not actively pushing. The second stage begins when the cervix is fully dilated and continues until your baby is born. Positions that feel helpful can look different between these stages, and you may want to change positions several times.
First stage of labor: movement, comfort, and rest
During the first stage, the focus is on managing contractions, supporting the baby's descent and rotation, and finding ways to rest between contractions. Changing positions can help with comfort and may support labor progress. Upright movement, such as walking, standing, or kneeling, has been associated with a shorter first stage of labor in some research, although results are not consistent across all studies.
Some options to try include:
· Walking or slow dancing: Walking, swaying side to side, or slow dancing with a partner can keep you moving while allowing you to use support as needed.
· Standing and leaning forward: Lean over a raised bed, counter, birth ball, or your support person. This can take some pressure off your back and gives you room to sway or rock your hips.
· Supported kneeling: Kneel on the bed or floor and lean forward onto pillows, a birth ball, or the raised head of the bed. This can be a comfortable alternative if standing becomes tiring.
· Hands and knees: Position yourself on your hands and knees, using pillows under your knees or forearms for comfort. You can gently rock your hips or move them side to side.
· Side-lying: Lie on your side with pillows between your knees and under your belly as needed. This is a good option for resting while still allowing you to change your pelvic position.
· Sitting on a birth ball: Sit with your feet supported and make small circles, gentle rocks, or side-to-side movements. Have someone nearby for balance if needed.
· Lunging or stair stepping: With support, place one foot on a low step or stool and gently shift your weight. You can switch sides. Only use this if you feel steady and it is safe in your birth setting.
· Warm water and massage: A shower or bath (when appropriate for your birth setting) and gentle massage or counterpressure may help you cope with contractions.
Remember that you do not need to stay in one position for an entire contraction or for a set amount of time. You can move, rest, and change positions based on what feels helpful.
Second stage of labor: pushing and delivery
Once your cervix is fully dilated, you enter the second stage of labor. This is when your baby moves through the birth canal and is delivered. Some people feel most comfortable pushing upright, while others prefer positions that allow more rest or support. Research has not identified one position that is consistently fastest or safest for every person.
Depending on your comfort, mobility, and your care team's recommendations, options may include:
· Side-lying: Lie on your side with your upper leg supported by a partner, nurse, or pillow. This can be a useful option if you are tired or have an epidural. It allows you to rest between contractions and may make it easier for your care team to support the perineum.
· Hands and knees: Position yourself on your hands and knees, or lower onto your forearms. This may feel helpful with back discomfort and gives you another option if lying on your back is uncomfortable.
· Supported kneeling: Kneel on the bed and lean forward over the raised head of the bed, pillows, or a birth ball. Your partner or care team can help support you.
· Supported squat: Use a squat bar, partner, or other stable support to help you squat. Squatting is an option for people who feel steady and have the strength and support to maintain the position.
· Birth stool or toilet-style seat: A birth stool can provide a supported upright position. It may be helpful to change positions or rest between contractions if the position becomes tiring.
· Semi-reclined or upright sitting: Raise the head of the bed and use pillows or supports. This can be a practical option when you need monitoring or assistance, while avoiding lying completely flat.
What if I have an epidural?
An epidural does not automatically mean you have to give birth lying flat on your back. Depending on the type of epidural, your strength and sensation, the monitoring equipment, and hospital policy, you may still have options such as side-lying, supported sitting, or modified hands-and-knees positions. Some hospitals offer peanut-shaped balls or pillows to support side-lying positions and help you change the position of your hips.
With an epidural, always ask your nurse or care team before getting out of bed or changing to a position that requires standing. Even when walking is not safe, your team may be able to help you make smaller position changes in bed. The World Health Organization recommends supporting a person's choice of birth position with or without an epidural when it is clinically feasible.
Are certain positions better for preventing tearing?
This is a common question, and the answer is not as simple as choosing one position. Research comparing upright and lying-down positions has not shown a consistent difference in severe (third- or fourth-degree) tears. Some analyses suggest that individual positions may have different effects, but the evidence is limited and does not establish one position as the best way to prevent tearing.
Instead of focusing only on position, it may be helpful to discuss other perineal-protection options with your care team before delivery. Evidence supports offering a warm compress to the perineum as the baby's head stretches the tissue. Perineal massage during the second stage may also reduce the risk of more severe tears. These techniques should be discussed with your clinician and used with your consent and comfort in mind.
You can also ask your care team how they support a slow, controlled birth of the baby's head and how they approach perineal support. No technique can guarantee that tearing will not occur, but having the conversation ahead of time can help you understand your options.
Is there a position that makes delivery faster?
Upright movement during the first stage of labor may shorten the time before full dilation for some people. However, when it comes to the actual pushing stage, evidence does not show that one position consistently leads to the fastest birth. The second stage is influenced by many factors, including the baby's position and size, whether this is your first vaginal birth, use of an epidural, and how labor is progressing.
Rather than trying to choose the fastest position, think about having several options available. A position that feels comfortable and allows you to rest may be more useful than one that is physically demanding. If pushing is not progressing, your care team may suggest changing positions, emptying your bladder, adjusting support, or other steps based on the situation.
A few things to talk about with your birth team
· Can I change positions and move around during labor when it is safe to do so?
· What position options are available if I choose an epidural?
· Do you have a peanut ball, squat bar, birth stool, or other positioning supports?
· Can we discuss warm compresses or perineal massage during the pushing stage?
· How will you support me if I want to try side-lying, hands-and-knees, kneeling, or an upright position?
· What circumstances might mean we need to change positions for my safety or my baby's safety?
Remember, your birth experience may not go exactly as planned, and that is okay. Having an idea of the positions available to you can help you feel more prepared, but flexibility is important. Talk with your OB/GYN or midwife about your preferences before labor, and keep the conversation open as things change. Your care team can help you find positions that support your comfort while keeping you and your baby safe.
References and further reading
1. American College of Obstetricians and Gynecologists. Approaches to Limit Intervention During Labor and Birth. Committee Opinion No. 766. 2019. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth
2. American College of Obstetricians and Gynecologists. First and Second Stage Labor Management. Clinical Practice Guideline. 2024. https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2024/01/first-and-second-stage-labor-management
3. World Health Organization. WHO recommendations: Intrapartum care for a positive childbirth experience. Recommendations on birth position and techniques to prevent perineal trauma. https://www.ncbi.nlm.nih.gov/books/NBK513805/
4. National Institute for Health and Care Excellence. Intrapartum care (NG235). Recommendations on position, pushing, and perineal trauma. 2023, updated guidance. https://www.nice.org.uk/guidance/ng235/chapter/Recommendations
5. Cochrane. Perineal techniques during the second stage of labour for reducing perineal trauma and postpartum complications. 2024. https://doi.org/10.1002/14651858.CD016148
6. Laderas-Díaz E, et al. Maternal Positioning in the Second Stage of Labour and its Relationship with Perineal Trauma: A Systematic Review and Network Meta-Analysis. International Urogynecology Journal. 2026. https://pubmed.ncbi.nlm.nih.gov/41572012/
* Disclaimer: The information provided in this article is intended for general educational purposes only and is not intended to replace individualized medical advice, diagnosis, or treatment. Every labor and delivery experience is unique, and positioning options may vary depending on your health, your baby's position, labor progression, and medical circumstances. Always consult with your OB/GYN, midwife, or healthcare provider regarding your individual needs and birth preferences. Decisions regarding labor and delivery should be made in collaboration with your healthcare team to prioritize the safety and well-being of you and your baby.
