Alternative Positions for the Laboring Woman

Alternative positions for the laboring woman may prevent some cases of dysfunctional labor (stalled labor or ineffective contractions) while facilitating the birth process.

Changing positions during labor and birth is considered by many professionals to reduce maternal distress, elicit more effective contractions and maintain labor progress for many women. Fewer medical interventions may be required, and positive outcomes for mother and baby may be achieved.

First Stage – Dilation and Effacement

Walking, leaning against a wall or her partner in a slow dance swaying movement, may help stimulate contractions while enlisting gravity to bring the fetus down.
Asymmetrical kneeling or standing as in a lunge may assist in fetal rotation, and provide relief from backache. (The woman kneels or stands with one knee and hip flexed above the other.)
Kneeling on all fours, over a chair, or birth ball while swaying the hips side to side can relieve back pain and help rotate the fetus from occiput posterior to occiput anterior.
Standing beside the bed and leaning over a birth ball placed on the bed may assist fetal alignment with the pelvis. These positions have the potential to resolve some fetal heart rate problems by relieving cord compression.
Sitting and swaying while bouncing on the birth ball, or sitting in a rocking chair, or glider, allows the laboring woman the opportunity to rest while continuing to engage gravity in order to assist the baby’s descent. Fetal heart rate can easily be monitored while she is in these positions.
Sitting backwards on a chair will enlarge the pelvis, engage gravity and provide rest for the woman in labor.

Spontaneous bearing down and gravity enhancing positions during the second stage are believed by many to decrease fetal hypoxia and acidosis as well as maternal hypotension and too rapid distention of the vaginal tissues, leading to lacerations or the need for episiotomy. Since the second stage of labor may take up to several hours, it can be advantageous for the laboring woman to continue to move in between contractions. Any of the positions described earlier in this section can be used. If forceps, vacuum extraction or episiotomy is required, the lithotomy or supine position may be necessary.

For the actual birth of the baby the laboring woman may be encouraged to assume a side-lying position. She can hold her upper leg or she may use the leg support that is part of her bed.
The back of the bed can be placed in an up-right position. The laboring woman would kneel in the bed while draping herself over the up right back of the bed. The bed may be broken to assist the woman to squat at the end of the bed while using the squat bar (if available).

The importance of varying maternal position during the first and second stage of labor does not diminish with the use of epidural anesthesia. Move or roll the woman from side to side. This will require time and effort as it should be done every ten to fifteen minutes, as it is felt that with each movement (position change) there is decreased risk of difficult labor. For the birth, the side lying position has been found to provide good results.

The Labor Progress Handbook, Penny Simkin and Ruth Ancheta, Blackwell Science Inc., Malden, Mass, 2000

Episiotomy and the Second Stage of Labor, Sheila Kitzinger and Penny Simkin, Penny Press Publications, Yakima, WA, 1984

Family-Centered Maternity and Newborn Care, A Basic Text, 4th Ed., Celeste R. Phillips, Mosby, St. Louis, MO, 1996

OB-GYN 101 Alternative Positions for the Laboring Woman

First Stage – Dilation and Effacement

OB-GYN 101
Alternative Positions for the Laboring Woman