Let’s Talk About Labor Positions!

It's Labor Day in the States. So, to honor that, I want to talk to YOU about Labor Positions. Specifically, I want to teach you which are the best, which are the worst and which depend on the situation :).

Wait...There's more than one labor position?

Sadly, there is a common misconception that the only position a person can have a baby in, is on their backside. It's technically called the lithotomy position. That's true. You can look it up.

The lithotomy position has traditionally been the most common position for women to have their babies in, in the United States...but NOT because it's the best for mom & baby, but rather because it "provides the doctor with easiest access to mother & baby."  It goes back to the olden days when women would be put in "twilight sleep" to deliver the babies.

Please excuse me while I telegram the 1900s and see if they want their preferred labor position back.

So, is the lithotomy position bad?

Jack Black, in his band "Tenacious D", once said-sung, "What's Your Favorite Posis(tion)? That's cool, it's not my favorite, but I'll do it for you..."

That's how I feel about lithotomy. It's not my favorite (for reasons we'll discuss in a moment), but if it works for you, it works for you. And...spoiler alert...

I had both my babies in lithotomy position

Yep. Truth.

Q: Is it weird that I'm strangely embarrassed by that?

A: YES! What the heck kind of a society judges a mother by how she does, or doesn't have a baby? She just grew a human inside her abdomen, then brought them into the outer world. That's boss.

When the time comes for you to bring your little bundle into the world, there will be some things you can control, and some things you can't. And you HAVE to let go of the control, and be at peace with what happens.

So here are my top 3 Labor Position tips for which positions have the highest rates for perineal tearing, which positions have the lowest rates for perineal tearing, and what will help you reduce your risk of perineal tearing REGARDLESS of which position you end up in.  Are you ready? Me too:

Top 3 Labor Position Tips from a Pelvic Floor Expert, Board Certified Pelvic PT

1a. Lithotomy is not the devil

Studies have shown that labor in the lithotomy position is correlated to higher levels of maternal pain in second stages of labor (Valiani, 2016) (. BUT lots of people end up here (including yours truly...TWICE!!)

1b. And if you do end up in lithotomy...consider this

The reason that lithotomy position is associated with increased pain is that the pelvis and sacrum are blocked from moving by the firm mattress. The pelvis & sacrum need to move to let baby down and out.

Counter this by having a softer mattress, having a small pillow or two under one half of your body (and alternate this every 45 minutes or so), to allow space for the sacrum and tailbone to MOVE.

Also, focus on moving our pelvis, as able, between contractions, and relaxing your pelvic floor within each contraction, to allow the uterus to push the baby down and out, with as little resistance from the pelvic floor muscles as possible.

Or, simply MOVE!!!  

- Can you move to all fours, and try a simple cat-cow position 

- What about knees out to open the pelvic inlet, if your contractions are less than a minute-long, or knees in, feet out, if your contractions are longer than a minute, to open the pelvic outlet?

- If you can't get on all fours, ....read on... :)

2. What position is best for fastest labor?

I will answer your question. BUT, remember this:

'Fast' labor does not equal 'better' labor

This. is. hugely. important. to. understand.

A slow gradual progression of labor allows the tissues time to stretch, and adapt to the pressures of emerging baby.

A faster labor can result in greater levels of pain & tearing, especially in first time moms.

But what position does result in fastest labors?

Squatting, of course. Squatting is the position that is associated with the fasted labor and deliveries.  It aligns our openings, and uses gravity to our advantage.  If you can relax your pelvic floor muscles & let the uterus do it's work, the labor position of squatting has the 'fastest' rate of delivery (Jansson, 2020).

And....squatting ALSO has the highest rate of perineal tearing, especially in first time moms.

So while it's GREAT for laboring, especially if labor is stalling, I rarely recommend that first time moms deliver in a squatting position due to risk of tears.

(but kneeling, or half kneeling, or all fours are ALL GREAT positions :) :) 

3. What labor delivery position has the lowest rate of tears?

I thought you'd never ask :). Side-lying position has the lowest rate of perineal tearing (same Jansson study, 2020). It also has the bonus of being a good position if you have orthopedic hip issues, or are suffering from a lumbar disc or stenosis during time of delivery.  

You can also use the side-lying position easily with a peanut ball even if you have an epidural, where you cannot feel your legs, as you can move from one side to the other in bed, with the help of others.  

Wow! Thanks, Dr. Kelly! Do you have any other awesome Labor Tips??

YES, the most important tip of all, is to learn to connect to, and relax your pelvic floor.  During pregnancy, you need to learn to "activate your abs as your pelvic floor stays relaxed", so the pelvic floor can stay healthy as you grow your baby.  Then for delivery, the pelvic floor needs to learn to stay relaxed during the INTENSE feelings of uterine contractions.  

Your uterus pushes your baby out, not your pelvic floor.  Your job is to keep your pelvic floor healthy and pliable to be able to move out of the way of delivery day. 

All my online courses, teach this, and in 2025, the Treasure Chest is being reorganized to include pregnancy and postpartum sections, but for now, Push Prep will remain a stand alone special course, due to the time intensive nature of staying up to date on labor and delivery research.  

I'm so glad you read this post!!!  If you enjoyed it, you can read ALL my tips in my hit Push Prep class, available for immediate streaming on all compatible devices :) It includes detailed instruction in stages of labor, what position are best for each stage, and for "unexpected stuff" like back labor or crotch pain in labor.  It includes training for you AND your birth partner, including what's THE ONE HUGE SAFETY THING that I wish EVERYONE KNEW when getting an epidural?? AND the downloadable Birth Partner PlayBook, so that your Birthpartner doesn't have to cover their arm in Sharpee-Labor Positions (yes, that is based on a real story...which I actually LOVE, but don't necessary want you to repeat).  Don't miss that class, for realsies.

THANK YOU for being here, I sincerely appreciate it, and feel blessed to be a part of your story.  If this blog helped you, or taught you something, please tell someone about it, or share it to your socials, or better yet, check out the studies and make your own sweet blog or social post (and tag me in it, so I know I made a difference!). WOOT!

Thanks for being here :) :) 

XOXO

Dr. Kelly 

Find a Pelvic PT Near You

Schedule an Appointment in-person or online!

Follow on Instagram

For every four online courses sold, one is donated to someone in need through our People Before Profits program. LEARN MORE 

 Geeks of the Internet, UNITE!  References, HERE!!

Jansson MH, Franzén K, Hiyoshi A, Tegerstedt G, Dahlgren H, Nilsson K. Risk factors for perineal and vaginal tears in primiparous women - the prospective POPRACT-cohort study. BMC Pregnancy Childbirth. 2020 Dec 2;20(1):749. doi: 10.1186/s12884-020-03447-0. PMID: 33267813; PMCID: PMC7709229. link here

Valiani M, Rezaie M, Shahshahan Z. Comparative study on the influence of three delivery positions on pain intensity during the second stage of labor. Iran J Nurs Midwifery Res. 2016 Jul-Aug;21(4):372-8. doi: 10.4103/1735-9066.185578. PMID: 27563320; PMCID: PMC4979260, or click here)