Birth positions: options for labour and how they can help
The position you adopt during labour is one of the things you have real control over, and it can make a meaningful difference to how your labour progresses and how you experience it. Many people arrive at hospital expecting to labour and give birth in bed, on their back, because that is what is commonly shown in films and on television. In reality, a wide range of positions are available and actively encouraged by NHS midwives. Understanding your options ahead of time means you can try different positions with confidence, respond to what your body is telling you, and make choices that support you at each stage.
Why position matters in labour
Position affects labour in several ways. When you are upright, gravity assists the descent of the baby through the pelvis. Upright and mobile positions also allow the pelvis to move more freely, which can help the baby navigate the different angles it needs to pass through during descent and rotation. NICE guideline NG235 on intrapartum care explicitly recommends that midwives encourage and support women and people in labour to be upright and mobile if they wish to be.
In the first stage of labour, when contractions are opening the cervix, keeping mobile and changing positions regularly can help manage pain and keep things progressing. In the second stage, when you are pushing, an upright position allows gravity to work in your favour and can give you more space in the pelvis compared to lying flat on your back. The NHS advises that you can choose any position that feels comfortable and effective for you, and that your midwife can help you find what works best.
It is also worth knowing that you are not committed to one position throughout labour. Most people move between several positions as their labour progresses, responding to what feels most manageable at each stage. Your midwife can monitor your baby's heartbeat and check your progress in almost any position, so you do not need to lie flat for routine checks unless there is a specific clinical reason.
Upright positions: standing, walking and leaning
Standing and walking are among the most straightforward ways to stay upright during the first stage of labour. Moving around helps the baby move down through the pelvis and can shorten the overall duration of labour. Between contractions, walking the corridors of a birth unit or moving around a room at home is something many people find helpful in early labour.
Leaning forward during a contraction, with your hands on a wall, a bed, a chair back or a birth ball, takes weight off your back and allows the pelvis to tilt in a way that many people find reduces pain. Rocking your hips during a contraction, or swaying from side to side, is a very common instinctive response to the sensation of a contraction and there is nothing stopping you from doing it. A birth ball can be particularly useful here: sitting on it and rolling your hips keeps you upright while taking some weight off your legs.
If you are planning to use a TENS machine for pain relief, you can continue to use it while standing or moving around, as long as you are not in water. This makes upright positions and TENS a natural pairing for early labour at home or in the early stages at a birth unit.
Kneeling, hands and knees, and all-fours positions
Kneeling is another upright position that removes direct pressure from the back and allows the pelvis to remain mobile. You can kneel on a mat on the floor, on a bed, or use a birth pool edge for support. Some people kneel upright; others find leaning forward onto a birth ball or the edge of a bed more comfortable. Kneeling keeps gravity on your side while giving you solid support through the upper body.
The hands and knees position, sometimes called all-fours, is particularly valuable when the baby is in a posterior (back-to-back) position. In a posterior position, the back of the baby's head is pressed against the mother's spine, which tends to cause intense lower back pain during contractions, often described as back labour. Adopting the hands and knees position takes the baby's weight off the spine and can encourage the baby to rotate to an anterior (front-facing) position, which is easier for descent and birth. Even if the baby does not rotate, many people find the hands and knees position considerably more comfortable for managing the pain of a posterior labour.
In the second stage, the hands and knees position is a well-established option for pushing. It gives access to the perineum for your midwife and is associated with good outcomes for both first and second stages.
Squatting and supported squat positions
A full squat opens the outlet of the pelvis and allows gravity to assist the baby's descent during pushing. It is an effective second-stage position for many people. The challenge is that maintaining a deep squat under exertion requires strong legs and good balance. A birth partner, squat bar (available on some NHS delivery beds), or bed rail can provide the support needed to hold the position during pushing.
A supported squat, where a birth partner supports you from behind under your arms, allows you to drop into the squatting position during contractions and be supported through the effort of pushing without needing to hold the position independently. This can be a useful technique if you find a full unsupported squat difficult to maintain.
Side-lying is another option worth knowing about, particularly if you have an epidural that limits your ability to bear weight on your legs. Lying on your left side keeps blood flow to the baby uncompromised and allows you to push effectively. Your midwife can help you find a comfortable side-lying position and will lift the upper leg to open the pelvis during the pushing phase if needed.
Labouring and giving birth in water
Birthing pools are available in most NHS midwife-led units and alongside birth centres, and some consultant-led units have pools as well. Labouring in warm water is widely used for pain relief, as the buoyancy reduces the feeling of body weight, the warmth eases muscle tension, and the water provides a calm environment that many people find helps them stay relaxed between contractions.
Water birth, where the baby is born into the pool, is an option for low-risk pregnancies. Your midwife will discuss whether a water birth is appropriate for your circumstances as part of your antenatal care. If it is something you would like to explore, include it in your birth plan and discuss it with your midwifery team ahead of your due date so you know what to expect and what the unit's policy is.
One practical point: if you are using or planning to use a TENS machine, you will need to remove it before getting into water, as TENS and water cannot be used together safely. Many people use TENS at home in early labour and then switch to the birthing pool when they arrive at the unit.
Frequently asked questions
What is the best position for labour?
There is no single best position. Upright and mobile positions (walking, leaning forward, kneeling, hands and knees) are supported by evidence as beneficial in both the first and second stages of labour. The best position is one that helps you manage pain and feels right to you.
Can I give birth in water?
Yes. Birthing pools are available in most NHS midwife-led units and alongside birth centres. Water is widely used for pain relief in labour. Births in water are an option for low-risk pregnancies. Discuss this with your midwife and include it in your birth plan if it interests you.
What is the hands and knees position in labour?
The hands and knees (all-fours) position can help relieve back pain in labour, particularly when the baby is in a posterior (back-to-back) position, and may help the baby rotate to a more favourable position. It is also a comfortable position for pushing in the second stage.
Does being upright in labour really make a difference?
NICE guideline NG235 on intrapartum care recommends encouraging upright positions. Evidence suggests upright and mobile positions are associated with shorter labour, less need for epidural analgesia, and reduced likelihood of instrumental delivery.
Getting ready for your baby's arrival?
Cubby tracks feeds, sleep, nappies and your baby's vaccine schedule from day one, shared with everyone who helps care for them.
Start free