Optimal positioning in labour and birth

Video: What positions are best for giving birth?

In this video, a midwife talks through some of the best positions to give birth.

Research shows that adopting upright positions in labour can:

• Aid in the descent of baby through your pelvis
• Reduces the pressure on your aorta, the large blood vessel which transports oxygenated blood from your heart to the rest of your body. This in turn increases the oxygen supply to baby, and decreases the chance of abnormal fetal heart patterns and therefore reduces the chance of caesarean section.
• Allows baby to get into an optimal position for birth
• Make contractions less painful
• Increases the dimensions of your pelvic outlet, especially in relation to positions such as squatting or kneeling (Gupta et al, 2017)
• Improves your birth experience and satisfaction levels (Thies-Lagergren, 2013)
• Reduces perineal tearing (Zang et al), except for in the squatting position which increased the risk of 2^nd degree tears
• Reduces the need for instrumental birth (Zang et al)
• Reduces the chance of shoulder dystocia (When the baby’s shoulder becomes impacted on the mother’s pubic arch) (Zhang et al, 2017).

When giving birth it is good to be mindful of your coccyx (tailbone), if in an upright position your coccyx has been found to move out of the way as much as by 16 degrees, which gives your baby’s head more room to navigate the pelvis.  In positions such as lying down where your coccyx is against the bed, the flexibility reduced to 4 degrees (Borges et al, 2021).  If counter pressure is taken off the coccyx it can reduce the need for interventions such as caesarean section or instrumental birth (Edqvist et al, 2016).

Positions which allow flexibility in the coccyx:

• Squatting
• Standing
• Lying on your side
• All fours

Positions which put pressure on the coccyx:

• Lying on your back
• Semi sitting in bed
• Lithotomy (lying on your back and your legs in stirrups)

References

Gupta, J. K., Sood, A., Hofmeyr, G. J., et al. (2017). “Position in the second stage of labour for women without epidural anaesthesia.” Cochrane Database Syst Rev 5 

Edqvist, M., Blix, E., Hegaard, H. K., et al. (2016). “Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth.” BMC Pregnancy Childbirth  

Borges, M., Moura, R., Oliveira, D., et al. (2021). “Effect of the birthing position on its evolution from a biomechanical point of view.” Comput Methods Programs Biomed 

Zang, Y., Lu, H., Zhao, Y., et al. (2020). “Effects of flexible sacrum positions during the second stage of labour on maternal and neonatal outcomes: A systematic review and meta-analysis.” PubMed (nih.gov) 

Thies-Lagergren, L. (2013). The Swedish Birth Seat Trial. Published by Karolinska Institute. Printed by US-AB digitaltryck.