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Upright Labor Positions | Vaginal Childbirth Positioning Series | Image Courtesy of Jimmy Conover via Unsplash
Labor Positions | Vaginal Childbirth Positioning Series | Image Courtesy of Jimmy Conover via Unsplash

Upright Labor Positions for the Second Stage of Labor

If you missed part 1 in the vaginal childbirth positioning series, go back and read it here.

Childbirth/labor is quite an experience, and it can be scary waiting for the unknown. Being prepared, knowing, and being familiar with different options and labor positions is the best way to approach childbirth to help decrease as much anxiety should surprises arise.

This article will go over specific labor positions that help progress labor, and prevent perineal trauma.

As mentioned in Part 1: Pre-Birth article, it’s important to keep changing labor positions to help progress, preferably in different upright labor positions. As a reminder, the first stage is all about increasing the pelvic inlet to help guide the baby through the mid pelvis and finally towards the pelvic outlet/vaginal canal.

upright labor positions sitting on ball | image courtesy of Femina Staff

Early labor positions to help baby progress through inlet of pelvis:

  • Standing and leaning forward onto a partner, furniture, etc.
  • Knees on floor, arms over swiss ball leaning forward onto the ball
  • Hands and knees- knees angled away from each other
  • Walking, slow dancing
  • Sitting on swiss ball and performing gentle posterior pelvic tilts (think tucking tailbone under)

Mid labor positions to help baby move through midpelvis:

  • Stair walking
  • Side lunges
  • standing, hands and knees or kneeling positions with thighs rotated towards each other

It is no longer recommended to be lying flat on your back for a few reasons. We want to allow the sacrum to move freely, as the coccyx (or tailbone) naturally extends backwards to allow for the baby to come through the vaginal canal. The dimensions of our pelvic outlet increases in upright labor positions, specifically in squatting, kneeling or in the hands and knees positions. Gravity works against us when we are lying on our backs, sometimes making it harder for labor to progress.

Benefits of Upright Labor Positions

There are many benefits to upright positioning during labor, such as decreased likelihood of sustaining episiotomies, decreased use of forceps or vacuum assisted births, and decreased instances of fetal distress. However there is an increased risk of second degree tearing and possibly extra blood loss (although there are mixed results). While there is an increased chance of second degree tears, natural tearing is known to heal more effectively than episiotomies.

There is no one position that is best for everyone and having many options is best.

There is a passive second stage (when there is no urge to bear down), and an active second stage of labor (when you feel the urge to bear down/during uterine contractions). If you have difficulty feeling that instinctual urge to bear down, because of an epidural for example, have the nurse or midwife help let you know when the contractions are occurring. When you have breaks in between the contractions, you may want to try to changing to more upright labor positions. Try and practice these 5 labor positions to see how you and your pelvic floor feel.

upright labor positions Lying on Side with Ball | Image Courtesy of Femina Staff

Stage 2 upright labor positions:

  • Hands and knees: Heels are away from each other and toes directed inwards. This labor position is a great way to ease low back pain and expands the pelvic outlet, especially if you tilt your pelvis anteriorly (think “cat” pose or arching of your lower spine). You can put your arms on the birthing ball or at the head of the bed. With the support of your team and adequate muscle strength, it is possible to get into this position with an epidural.
  • Lying on your side: Try this with a peanut ball in between legs, or supported by your partner. This is a great labor position for when you need a break in between contractions but still opening up that pelvis and allowing coccyx to move freely. This is also what many people with epidural prefer.
  • Half kneeling: This can be done with a birthing ball, rail and/or supported by a partner, etc. Gravity is a plus in this position and helps open up the pelvis. If you suffer from pubic symphysis pain, this is not an ideal labor position for you.
  • Squatting: There are many versions of squatting with and without tools. You can bring your body over the birthing ball or put your hands around your partner’s neck or chair, and or on a birthing rail. Gravity is helping, but this labor position does carry an increased risk of tearing. It is recommended to start training in this position to improve flexibility and learn how to relax the pelvic floor in this position. Practice putting your feet in different positions (toes outwards, toes neutral and toes inwards) and in different pelvic positions (tucked under, or leaning forwards/arched).
  • Sitting/birthing chair/toilet: Women often feel perineal relief in this position, but sometimes experience some irritation from the toilet seat. This can be another good labor position for those with epidurals. However, this position can sometimes increase blood loss and it is not an ideal position for those with high blood pressure.

upright labor positions hip ER on ball | image courtesy of Femina Staff

If having an epidural, it is possible to get into a squatting or hands and knees position with arms holding onto something strong and sturdy. But it does depend on the strength stability of your legs and your support/birth team to ensure it is done safely.

See a pelvic floor physical therapist to help you go over upright labor positions that make the most sense for you, and start practicing! Check out next week’s blog on the 3rd Stage of Labor.

upright labor positions hip IR on ball main 600p

References:

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/

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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 Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by Ann V.

I wish i could give this place 10 stars!! 
I have been suffering from vaginismus for 5 years and never found the cure to it. I had seen an ob/gyn and he diagnosed me with vaginismus and told me i needed a surgery to cure my condition, which i refused to do. He also referred me to a PT that he works with, i had given them multiple calls and they never responded back to me, so i started searching yelp for another PT. I am SO HAPPY I found Heather's office! I was working with Laureen, and with her guidance and techniques i was able to be cured from vaginismus in only 2 1/2 short months!!! I couldn't believe how quickly their program worked for me! I am forever grateful and thankful from Heather, and Laureen! They are the absolute best at what they do!

Read more: Testimonial by Ann V.

Testimonial by Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

-- Carolina J., 12/28/16 via Yelp!

Testimonial by A.M.

Months after giving birth, it was difficult for me to go from a sitting or lying position up to a full standing position without feeling that I had to remain hunched over until a bit of time had passed to get fully upright. However, after taking Heather’s course, I learned exercises to get my body back to normal. She also showed me correct ways to lift and carry my son as well as put him in/take him out of the carseat and stroller. This class was really beneficial and Heather is a wonderful teacher who made me feel very comfortable.

-- A.M.

Testimonial by A.W., age 32

I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

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