Know Your Options | Pushing Positions for Labor
If you’re going by how birth is represented in the movies and on television, the formula is generally the same.
Someone’s labor begins with their water breaking in spectacular fashion in a public place, like a Costco. Immediately, their contractions begin at full-force, and the birthing person is yelling at everyone in sight. We jump cut directly to the hospital, where they’re being wheeled into a labor and delivery room that looks way more like an operating room. Lying on their back, they give several screaming pushes, and out pops a very clean 3-month-old. Congratulations, new parents!
In reality? Only 10% of labors begin with your water breaking. Most people’s labor starts with mild, almost unnoticeable contractions, and the average person’s water breaks around 8 cm.
What if you’re one of the few whose water does break? Well, it’s way more likely to be a trickle than an enormous gush, leading many to first question if they've peed their pants (again). Also, it usually takes our body several hours to get the memo we’re in labor, so it’s considered normal for a long while to pass before you notice any contractions.
Think you should head into the hospital ASAP or you’ll have your baby on the highway? Most first time parents spend a significant time laboring at home before they head into their hospital. It’s pretty standard for many hospitals to admit you once you’re in active labor, around 6 cm, encouraging you to head home and rest if you still have more time.
As for that pushing thing? Well, this is the one piece we wish weren’t as true-to-the-movies. Despite the evidence telling us we should use gravity-friendly positions during pushing, a recent study showed 68% of birthing people still gave birth on their backs.
Why would we try to avoid pushing flat on our back? Well, for one we’re working harder, not smarter. Being flat on our back isn’t working with gravity and the reflexive pressure of our uterus. Being on our back also closes off our pelvic outlet, allowing our sacrum to narrow the opening, which makes baby’s exit door smaller.
On average, it takes a first-time parent two to three hours to give birth to their baby during the pushing phase of labor. Parents without an epidural trend closer to two hours, while families using an epidural as part of their comfort plan are closer to three hours for pushing. Why is this? An epidural can limit our ability to get out of bed, and unfortunately, most parents who have chosen an epidural don’t realize they can still use gravity friendly positions during labor!
Let’s break down some of our favorite pushing positions, when to use them, and who can use them depending on any limitations you may have during labor.
Water birth
Waterbirth is its own special category that can utilize numerous pushing positions as well as the benefits of being in the water.
Benefits: Evidence shows water birth is a gentler transition for babies, can reduce our risk of tearing, and hydrotherapy provides additional comfort and pain relief to parents.
Who can use it?: Most people choosing a home birth or birth center birth will have the option for a water birth. If you’re birthing in a hospital, check if your provider has experience with water birth and what the hospital policies are regarding the option. Unfortunately, water birth availability at hospitals varies by provider practice, hospital, and state.
Birth Stool
Benefits: A birth stool allows you to have the same relaxed sensation in your pelvic floor while providing more access for your provider team to help catch your baby. Your body is also in a supported squat, opening your pelvis by 30%. If your baby needs support to rotate into a better position, the birth stool uses the benefits of a squat position, while allowing the birthing person to rest a bit more.
Who can use it: If you haven’t had an epidural, you can use a birth stool at any location in your birth space. Some people who have had an epidural may be able to be helped into a supported enough position to use the stool in their bed.
All-Fours/Hands and Knees
Benefits: Uses gravity, while also allowing the birthing person to rest as they lean forward. This position can also reduce our risk of tearing because we’re able to slow down pushing as our baby crowns.
Who can use it: Anyone, even folks with epidurals! Simply ask for the head of your bed to be raised or a tool called a cub to provide support for your upper body. It’s important to know that some providers prefer to not catch babies in this position, but this doesn’t have to stop you. Discuss birthing your baby in the position ahead of time and know it’s your right to give birth in whatever position you’d like.
Semi-reclined
Benefits: Being in a semi-reclined position doesn’t put you flat on your back, instead it’s more of a supported squat. This can be a great position to use to rest, alternating between this and a more upright position.
Who can use it: Anyone. It can be especially comforting to recline back into the lap of a partner, adding comfort to your pushing. If you have an epidural, be careful not to pull back on your legs too hard, as this can stress the tendons in your hip flexors and cause injury.
Side-Lying
Benefits: Much like the semi-reclined position, this can be a wonderful position that allows rest in between pushing.
Who can use it?: Every birthing person can try this position. Don’t be surprised if your baby favors one side over the other, that can be a common variation during pushing.
Squatting
Benefits: Like we said, squatting opens up your pelvis by 30%! This position can be taxing, so take advantage of support tools to give yourself a break. Hold your body up on your partner, use a birth sling or a squat bar attachment to your hospital bed.
Who Can Use It: Like we said, there are plenty of ways to support a squat, meaning everyone should be able to take advantage of this stellar position. People with an epidural can use a squat bar and support from their team to get into position for pushing.
Lunging/Kneeling Lunge
Benefits: You can lunge in a standing or kneeling position, opening up one side of your pelvis more than the other. This position is also helpful to help rotate a baby who is facing sunny-side-up or coming through the pelvic outlet at an angle.
Who Can Use it: Anyone, even people birthing with an epidural. If you’ve chosen an epidural, you can set yourself up similarly to in all-fours, bringing one leg up with the support of your team, either holding it for you or helping you raise and lower the leg. Folks having a water birth can use a ledge in the tub or a partner to hold their leg up.