What position should you be in for an epidural?

9 Labor Positions to Try While Giving Birth

Did you know the standard hospital labor position (reclining on the bed) isn’t always ideal for delivering a baby? There are nine labor positions you can try to ease discomfort during contractions.

By Kim Schworm Acosta
and Susan Ashmore
Updated on November 23, 2022
Trending Videos

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Reclining May Not be Right for Everyone

While everyone is different, for some people, the standard hospital labor position—semi- or fully reclining—is not always ideal. For instance, the simple act of gravity and being more upright may help the baby move down the birth canal during labor.

For another thing, when you’re lying on your back, your uterus compresses major blood vessels, potentially depriving the baby of oxygen and making you feel dizzy or queasy. «Most women feel better when they are not lying on their back during labor,» says certified nurse-midwife Katy Dawley, Ph.D., C.N.M., director of the Institute of Midwifery at Philadelphia University in Pennsylvania.

In addition, when you’re reclining, the baby’s head puts pressure on pelvic nerves in your sacrum, which could increase pain during contractions. Again, everyone is different and the standard position may be perfectly fine, especially if you have a full epidural, but if you’re not feeling comfortable, let your delivery nurse know so you can try other positions.

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The Benefits of Upright Labor Positions

Some people may find staying upright is more comfortable during labor. And as a bonus, it could even speed up labor too. This is because when you’re in labor, remaining upright and leaning forward reduces pressure while allowing the baby’s head to constantly bear down on your cervix. As a result, dilation tends to occur more quickly. «Lying on your side, standing, sitting, walking, rocking—anything that keeps you active can help decrease pain and speed up labor,» says Dawley.

Other benefits of upright labor positions include:

Reduced need for medication
Help in dilating your cervix and widening your pelvic opening
Greater sense of self-confidence and self-control
Stronger, more efficient, and less painful contractions
Aid for the baby’s descent through the birth canal
Help in bringing oxygen to the muscles in your uterus and to the baby
Reduced need for episiotomy or cesarean section
Less stress on the baby

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Finding the Best Labor Position

That being said, it’s important to remember that isn’t one best labor position for you. In fact, it’s a good idea to change positions during labor so you don’t develop a cramp or strain your muscles. Here are nine effective labor positions you can learn about now so you’re more prepared to try them if you’d like during labor. And don’t forget to keep in mind that moving around is generally only possible if you don’t have an epidural; people who use an epidural for pain management may be more limited in the positions they can choose during labor.

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Squatting

Squatting can be especially effective when you’re ready to push. In fact, squatting is sometimes called the «midwife’s forceps» because of its ability to work with gravity, enlarge the pelvic opening, and speed the pushing phase of labor.

Try squatting supported by another person or a sturdy chair. You can also squat against a wall or between your partner’s legs while they sit.

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Sitting on a Ball

Try sitting with one knee bent and the other relaxed. Don’t lean too far back. When you sit, your uterus drops forward, improving the blood supply to the contracting muscles and easing pressure on your diaphragm. Use cushions or your partner for support.

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Lunging

Place one foot on a sturdy chair or stool and lean into that foot during contractions.

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Swaying

Wrap your arms around your partner’s neck or waist and sway as if you’re slow dancing. This is also a great position for receiving a back rub!

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Standing

By standing upright, you let gravity aid you. During the first stage of labor, simply walking around can help things progress—but take care not to become too tired.

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Rocking

Sit on an exercise ball, the edge of the bed, or a chair. (Ask your nurse if the unit has a rocking chair you can use if you’d like!) Gently rock back and forth to ease pain during contractions.

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Kneeling

If you want to remain upright, but no longer feel comfortable walking, try kneeling on a pillow. This can help if your baby is pressing against your spine.

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Hands and Knees

If upright positions are tiring, or the contractions are too fast or overwhelming, an all-fours labor position can help. It gets gravity to work for you, slows down contractions, and eases back labor, which occurs when the baby is positioned with the back of their head pressing against the rear of your pelvis.

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Lying on Your Side

Consider trying a sideways position if you’re tired or have had an epidural. It takes weight off the main blood supply to the baby and reduces tension on your perineum. If you are having a lot of back pain during labor, you can also ask your partner to apply gentle counter-pressure to your back to relieve pressure from the baby’s head moving down. (Have them make a fist, cover that hand with their other hand, and apply gentle pressure with both hands on your back where it is hurting: labor and delivery nurse tip!)

How to Push Your Baby Out With an Epidural

Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.

Updated on June 14, 2021

Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association.

Epidural anesthesia is the most common form of anesthesia used in childbirth. Since an epidural numbs the entire area between your breasts and knees, you might wonder how you can push your baby out during labor.

Some studies have looked at whether or not having an epidural alters how you push your baby out. However, the results have been mixed.

A 2017 review of those studies found that for women on epidurals, delaying pushing during the second stage of labor increased the stage by 56 minutes. Overall, however, it was unclear whether the timing of when to start pushing had any lasting impact on moms or babies.

The American College of Obstetricians and Gynecologists has since changed its stance on delayed pushing. They now favor pushing based on cervical dilation.

The Urge to Push With an Epidural

Near the time of birth, laboring women experience the urge to push. Sometimes this urge is overwhelming and women describe it as something that their body is doing and they have no control over it. Other times, it simply means that it feels better to push, particularly at the peak of a contraction, than it feels to not push.

For some women, an epidural can dampen or eliminate the urge to push in the second stage of labor. This lead to the theory of laboring down, a term that describes waiting to push until the baby is fairly far down into the pelvis.

This allows the mother to rest and was thought to prevent:

Fetal distress
Prolonged pushing
Some fetal malpositions or allow the baby time to rotate into a better position
The mother from feeling incredibly exhausted from pushing efforts

As of 2019, the American College of Obstetricians and Gynecologists no longer supports the practice of laboring down and suggests a woman starts pushing when her cervix is fully dilated.

Pushing Positions With an Epidural

Since an epidural anesthetizes the mother, she may not be able to assume as many positions because of the lack of feeling. This puts a limit on the number of possible positions, which can hinder progress during labor.

This varies from mother to mother. Some women will have more movement than others, and while this might alter what positions you can use, it will still usually require a lot of support from those around you.

With good support from your partner, a doula, labor nurses and others, there are several effective positions the mother can use for pushing including:

Kneeling at the foot of the bed, leaning over
Semi-prone
Semi-sitting with leg supports
Side-lying
Supine with stirrups or leg supports
Supported squat

Use Caution

One thing to keep in mind when helping a woman with an epidural is to be careful never to over-extend her legs or other joints. It is possible to cause harm to the mother’s body because she is not able to feel pain, and may not know when to tell you to stop if her joints are overextended.

Epidural Complications

While the reduction of pain is a benefit of an epidural, this medication also increases the risk that you will:

Increase the length of the second stage because your muscles are less able to help rotate your baby into preferred positions for childbirth
Have an episiotomy
Need forceps or vacuum extraction
Need more time for pushing than you would otherwise
Need Pitocin, the synthetic form of the hormone oxytocin

The use of an epidural will most likely not have any great effect on your ability to push, with the most likely complication being a lengthier pushing phase. That said, many women gladly trade a few extra minutes of labor with the pain relief provided by the epidural for the alternative.

A Word From Verywell

If you are planning to have an epidural, talk to your doctor and doula about how you want to handle the pushing phase of labor. Knowing your options and having a birth plan in place can help you make the right decisions about this aspect of labor and delivery.

5 Sources

Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American College of Obstetricians and Gynecologists. Medications for Pain Relief During Labor and Delivery. 2017.
Lemos A, Amorim MM, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down methods for the second stage of labour. Cochrane Database Syst Rev. 2017;3(3):CD009124. doi:10.1002/14651858.CD009124.pub3
ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol. 2019;133(2):e164-e173. doi:10.1097/AOG.0000000000003074
Osborne K, Hanson L. Labor Down or Bear Down: A Strategy to Translate Second-Stage Labor Evidence to Perinatal Practice. J Perinat Neonatal Nurs. 2014;28(2):117-126. doi:10.1097/JPN.0000000000000023
Walker KF, Kibuka M, Thornton JG, Jones NW. Maternal position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev. 2018;11:CD008070. doi:10.1002/14651858.CD008070.pub4

By Robin Elise Weiss, PhD, MPH
Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.

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