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Pre-Birth Stage of Labor
Childbirth Positioning For Each Stage of Labor | Image Courtesy of FreeStocks via Unsplash

Positioning for the Pre-Birth Stage of Labor

What to Expect and What to Focus On:

If you have been pregnant for many months now, it is time to get ready for your upcoming birth! Similar to a marathon, we need to train for childbirth to prepare the muscles and body for the big event. For this reason, it is a good idea to start practicing being in different positions either with movement or holding a position for a long time. The pre-birth stage of labor involves contractions to dilate and open the cervix. Once the cervix is fully dilated, the second stage includes the passive and active phases of the baby crowning and coming out of the vaginal canal. The third stage involves the delivery of the placenta. We will go over how to best support our bodies throughout your childbirth journey.

Positioning for the Stages of Labor

Practicing and knowing different positions during this first stage can be helpful when pain may escalate. Upright positioning such as: walking, standing, rocking back and forth, kneeling over birthing ball, leaning against wall, holding onto partner are just some of the many, many positions that can be helpful.

First Stage of Labor Positioning : Sitting Upright | Image Courtesy of Femina PT StaffFirst Stage of Labor

First stage of labor positions are more focused on increasing the pelvic inlet, the top bony ring of your pelvis, to help guide the baby towards the vaginal canal. These positions also help decrease low back pain. The key in the pre-birth stage of labor is to incorporate your preferred but various upright positions to help decrease pain and promote dilation of the cervix. Women who are in more upright positioning and with more frequent changes of positions during the first stage of labor have been found to have a shorter second stage of labor and are less likely to have a cesarean section.

Second Stage of Labor

It is also important to find your optimal positions for the second stage of labor. During this stage, we want positions to help expand the pelvic outlet, the lower bony pelvic ring. During vaginal childbirth, the pubococcygeus muscle (the “kegel” muscle of the pelvic floor) stretches 3.26 times more than its normal length! So although it is common to assume we need to be strong and strengthen the pelvic floor, it is equally, if not more important, to also be able to lengthen and relax the pelvic floor. It is a good time starting at around 34-35 weeks pregnancy to practice releasing and bearing down without straining the pelvic floor muscles. Incorporating perineal massage techniques around this time can also help improve the ability of the pelvic floor to expand/lengthen and thus decrease the risk of perineal trauma. When the uterus contracts, pelvic floor muscles should ideally lengthen to help the baby make its way in and out of the vaginal canal.

For positions during the second stage of labor, it is important to:

  • Find which positions make you feel relaxed and easy to release those pelvic floor muscles...and then,
  • Practice in those positions that allow for maximal space in the pelvis!
  • Have an already prepared paper that lists different positions that you like so when you’re in labor, you won’t have to think- but partner/doula/nurse can look at the document quickly and get you in position

Upright positions help decrease low back pain, shorten second stage duration, and decrease the likelihood of resorting to emergency cesarean sections, assisted childbirths (forceps, vacuums), and episiotomy procedures.

First Stage of Labor Positioning : Hip External Rotation | Image Courtesy of Femina PT StaffStart practicing being in different positions such as squatting, hands and knees, on your side with a ball in between knees, standing supported by your partner and see how your pelvic floor muscles feel.

A pelvic floor physical therapist can help you find positions that work for you during the pre-birth stage of labor. Please continue to read Parts 2 and 3 as they come out this month for more specific information on positions!



1. Abdelhaim AM, Eldesouky E, Elmagd IA, et al. Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Intl Urogynecol J 31, 1735-1745 (2020). https://doi.org/10.1007/s00192-020-04302-8

2. Ananda, Kara. Better Birthing Through Alignment: Optimal Labor Positioning. https://wellnessblessing.com/blog/2014/3/29/better-birthing-through-alignment-optimal-labor-positioning.

3. Dekker, Rebecca. The Evidence on: Birthing Positions. Evidence Based Birth. February 2, 2018. https://evidencebasedbirth.com/evidence-birthing-positions/.

4. Hofmeyr GJ, Singata-Madliki M. The second stage of labor. Best Practice & Research Clinical Obstetrics and Gynaecology: 2020, 67; 53-64. https://doi.org/10.1016/j.bpobgyn.2020.03.012

5. Tully, Gail. Three Levels of the Pelvis. Spinning babies. March 7, 2016. https://www.spinningbabies.com/optimal-maternal-postions-at-the-levels-of-the-pelvis/.

What Our Patients Have to Say


Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

Testimonial by S.B.

As someone who suffered the debilitating physical and emotional effects of vaginismus (as well as a complicated history of back injuries) for more than 15 years, I thought a "normal" life was just a fantasy. Then I found Heather.

Read more: Testimonial by S.B.

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

Testimonial by Rosanna R., age 35

Heather has affected my life in the MOST POSITIVE way and I am forever grateful. My husband refers to her as the "sex doctor" so you can only imagine how happy he is with my therapy outcome.

After the birth of my son I suffered from "Vaginismus", however, at the time I just thought I was broken. My "broken vagina" affected me physically but it was an emotional struggle as well. Many women in my life also suffered with pain from sex after their babies were born so I knew I wasn't alone. They told me they "just got used to it" but I couldn't see myself living that way.

Sex wasn't just painful, it was literally impossible - IT DIDNT FIT!

Read more: Testimonial by Rosanna R.,...

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