Best Birthing Positions to Avoid Giving Birth on Your Back (With or Without an Epidural)
Pushing on your back may be what most women envision for the grand finale of labor. But it’s not the only position—or even the best position—for giving birth. The best pushing positions help open your pelvis and work with gravity so you can finally meet your baby!
Pushing on your back gets a bad rap because it often works against gravity and pelvic alignment. This is why pushing on your back can increase your risk of tearing and interventions like a vacuum or forceps-assisted delivery.
Here are our tips for choosing the best birthing positions that increase your chances of a smooth delivery.
Change Positions to Get Baby in the Right Position
You don’t have to choose just one birthing position! Changing positions throughout labor is the best practice. Embracing a variety of positions helps move labor along and helps you find a pushing position that works for you.
Throughout labor, including the pushing stage, frequent position changes help your baby navigate through the birth canal. Your baby’s shoulders have to squeeze through and rotate, so position changes can optimize the space for the baby to move. Our Expecting and Empowered Labor Positions Guide can help empower you to choose and change positions as you progress! (That may mean telling your birth team you don't want to push on your back—as long as it is safe to do so.)
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Best Birthing Positions for Pushing
Pushing in upright positions—like standing, kneeling, or squatting—are some of the best birthing positions because they take advantage of gravity and help baby move down into your pelvis. Side-lying and kneeling on hands and knees (quadruped) positions are also good alternatives to pushing on your back. Most of these positions are ideal for women laboring without an epidural.
Quadruped Birthing Positions
Kneeling on hands and knees: Pushing on all fours with your ankles angled out also helps open up the pelvis. This is one of the best birthing positions to help relieve back pain when baby is in an occiput posterior presentation (aka sunny side up).
Hands and knees with birthing ball: This modified hands and knees position has you rest your upper body on a birthing ball to help decrease the pressure on your wrists.
Side-lying Birthing Positions
Side-lying: Birthing in the side-lying position with one leg bent and slightly raised helps baby descend more slowly, which reduces perineal tearing. This position also allows you to rest more between contractions. Putting a towel roll under your ankles can help keep your ankles outward and knees in for optimal pelvic opening.
Side-lying with birthing ball/peanut ball: This modified side-lying position helps you maximize space by elevating one leg with your ankle out using a birthing ball or peanut ball. You can also pull down on the bar of your hospital bed as you exhale to help increase abdominal contraction to push baby out.
Upright Birthing Positions
Standing: With the support of a partner or object like the side of a bed, standing helps open up the pelvis to help labor progress.
Squatting: Squatting increases the size of the pelvis to help make more room for baby to make its way down the pelvis. However, this position can put some extra pressure on the pelvic floor and is one of the most tiring positions.
Semi-squatted with birthing bar: Squatting can be exhausting, so adding a birthing bar to your squatting position helps take some of the weight off of your feet and legs to help conserve energy.
Best Birthing Positions With an Epidural
Women often believe you have to push on your back when you get a traditional (non-walking) epidural. That's not entirely true. In fact, it is possible to push in an upright position with an epidural.
Getting an epidural often still allows you enough sensation to change positions during labor– but you may need some assistance. However, what is safe for you will depend on your epidural experience.
Pushing positions that work best for epidurals include:
Side-lying with a peanut ball: If you have restricted movement with an epidural, try lying on your side with your top knee toward your chest. Your birth team can elevate your knee on a peanut ball. Putting a towel roll under the ankles can also keep your ankles outward and knees to help open the pelvis. Then, use the sidebar to push down to help your abdominal contact and assist pushing baby out.
Half Kneeling position with birthing bars: Leaning into or holding onto birthing bars can help you sit upright by giving you more support.
Is Giving Birth on Your Back Bad?
Pushing flat on your back can compress the tailbone and decrease space in your pelvis. This can make it more difficult for baby to move through the pelvis, increasing your risk of vaginal tearing and interventions to get baby out.
Research shows that choosing upright labor positions, especially for women without an epidural, comes with advantages like:
Reduced risk of interventions: Research shows women without epidurals had a decreased risk of fetal heart rate abnormalities, episiotomy, vacuum, and forceps-assisted delivery.
Fewer fetal heart rate abnormalities: Pushing upright helps improve blood flow, so baby gets more oxygen and can descend into a better position.
Quicker labor: Research on women with low-dose (walking) epidurals shows upright positions were linked to shortened labor and time pushing. We need more research on women with traditional (non-walking) epidurals.
Note: Some research has found that upright birthing positions may slightly increase the risk of second-degree tears and experiencing blood loss more than 500 mL.
What if You Need to Push on Your Back?
Sometimes plans change (and during labor things can change FAST!). Pushing on your back may become your preference or become unavoidable due to your unique birthing situation.
Try these tips to push on your back more effectively:
Use a towel roll: Place a towel roll under the right side of your sacrum (butt area). This helps create more space and relieves pressure that can lead to tailbone injuries.
Elevate your head: Have your birth team elevate the head of the bed a bit so you’re not completely lying down. Propping up your back also helps move your tailbone out of the way and relaxes your pelvic floor.
Push on a birthing bar: While in a semi-reclined position, you can still push down on a birthing bar (aka a squat bar) as you exhale to help keep your back straight. This helps the abs kick on to push baby out.
Remember, whatever position works best for you is the best pushing position!
SIGN UP FOR THE EXPECTING AND EMPOWERED LABOR + DELIVERY COURSE
Prepare for labor’s mental and physical demands with the Expecting and Empowered Labor + Delivery Online Course. Learn how movement helps labor progress and the best birthing positions with or without an epidural. Practicing breathing and understanding how to push will also empower you for the main event. Our course will teach you everything to help prepare your body, mind, and partner during the challenges of labor and delivery.
Sources
DiFranco JT, et al. (2014). Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body’s Urge to Push. https://pmc.ncbi.nlm.nih.gov/articles/PMC4235063/
Hofmeyr GJ, et al. (2018). Does Gentle Assisted Pushing or Giving Birth in the Upright Position Reduce the Duration of the Second Stage of Labour? A Three-Arm, Open-Label, Randomised Controlled Trial in South Africa. https://pmc.ncbi.nlm.nih.gov/articles/PMC6035507/
Shorten A, et al. (2002). Birth Position, Accoucheur, and Perineal Outcomes: Informing Women About Choices for Vaginal Birth. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1523-536X.2002.00151.x