Changing Positions during Labor  

Most women can’t spend their entire labor walking around. Especially in a long labor, you may need to alternate walking with resting. Brief periods of sitting, kneeling, or side-lying can help you rest by temporarily reducing the strength of your contractions. Simply changing positions regularly will probably help you to be comfortable longer than any one "best" position you could find. One study found that obstetrical patients assumed an average of 7.5 different positions in labor.

Joyce Roberts, Ph.D., Professor of Maternal-Child Nursing at the University of Illinois at Chicago points out, "A woman’s contractions are most efficient if she alternately sits and stands during labor." It’s also necessary, she says, to adopt positions that are comfortable and appropriate for your particular labor.

For example, you may need to be in bed because of bleeding, fetal distress, or premature rupture of membranes with your baby’s head in a high position. If you have received an epidural, you have to stay in bed. If you are instructed to lie on your back, make sure your head is elevated with pillows and that you have a pillow or rolled-up blanket under one hip to tilt your uterus off your backbone. According to Roberts, alternating every half hour between lying on your back and lying on your side can help prevent the adverse effects reclining has on your blood pressure, your baby’s heart rate, and your labor’s progress.

Side-lying makes contractions less frequent than when you are standing, but they are also more efficient. Best of all, side-lying is good for your blood pressure. In fact, because it enhances circulation to your uterus, this position is often employed when a baby appears to be in distress.

As long as your labor is progressing normally, however, you may want to try any or all of the following positions in preference to lying flat, which tends to lengthen your labor and add to its risk and discomfort:

•  STAND, leaning against your partner, a high counter, or a bed.

•  KNEEL on all fours or with your arms and head against some pillows on an upraised bed. You could also try this on the floor, leaning on a cushion placed on the seat of a chair.

•  HALF-KNEEL, HALF-SQUAT, with one knee up and one knee down, in bed or on the floor. This is easier than squatting, described below. If it feels good to you, rock back and forth toward your raised knee during the contractions. Change legs as needed.

•  SIT UPRIGHT in bed or straddle a chair, leaning on a pillow on the back of the chair. A review of labor positions by the International Childbirth Education Association concluded that labor contractions were least efficient in sitting and supine positions. But sitting may still afford you a needed rest.

•  SQUAT on the floor or on the bed. When you squat, your pelvic outlet opens to its widest diameter and your contractions will be strong and effective.

Before you go into labor, you should practice squatting to build up your endurance. With your feet one and a half to two feet apart and your heels flat on the floor, descend gradually, without bouncing, and hold the squat for 15 to 20 seconds. Work up to holding this position for a minute at a time. If you have trouble keeping your feet flat, widen your stance a bit, or try putting a rolled blanket under your heels, or wearing low heels, or sitting on a short stack of books. Rise up slowly and repeat several times. If you need help balancing, lean against your partner or grasp a chair or bed. It’s not a problem if your knees "crack," but don’t do this exercise if you feel pain in your knees or pubic joint.

During labor you can vary the squatting position by squatting on the floor, leaning on a chair or on the labor bed. Or ask your partner to sit down on the bed or chair; facing away from him, try dangling into a squat, resting your elbows on his knees.

You could also squat in bed, supported under your arms on one side by your partner and on the other by a nurse. Or try squatting on the side of the bed with your arms draped around your partner’s neck. Your partner could even sit behind you in bed, toboggan-style, supporting you under the arms as you squat. You could sit-squat on the low footstool in the labor room. Put a pillow and sterile pad on it, and just sit down with your knees higher than your hips. Or perch on a short pile of books, a large cushion, or a beanbag chair.

One mother who moved around a lot during her labor remembers, "standing, holding on to the bureau, and literally dancing through the contractions. At times I would go from sitting to standing to all fours. My husband danced along next to me, wiping my face with a cloth, following me when I started walking, letting me hold on to him. During transition, I climbed on the bed and got onto all fours, then walked around again when the contraction was over."

If you learn that your hospital’s or doctor’s custom is to confine all women to bed for the duration of labor, you may want to express your own wishes and come to a compromise. It may be a good idea to have any agreement you reach entered into your chart, especially if your doctor might not be at the hospital while you are in labor.

You could plan simply to arrive at the hospital at a point late enough in labor that you are willing to get into bed. Or you may decide to switch to a birthing environment that respects your need to be comfortably active during labor.