Positions for labor and childbirth

There's no best position for labor. Once you're in labor, experiment to find what's most comfortable for you. Listen to your body to discover what feels good. One tip: Give each new position a chance. The first few contractions may be stronger until you get used to a new position.

Lying flat on your back isn't recommended for labor or childbirth. It can cause the weight of your uterus to compress major blood vessels and decrease blood flow to your uterus.

Some of the positions for labor and delivery that you may want to try include:

The semireclining position

In the semireclining position, you lean back as if you're in a reclining chair. The head of the bed is elevated, and your head and shoulders rest against pillows. During each contraction you grab your legs behind the knees or handles near the stirrups and pull back toward your body. Or you may pull your body forward into a more upright position.

Standing or walking

If it's helpful — especially during early labor — stand up or take a walk. In particular, a labor that hasn't been progressing may gain some momentum if the mother stands or walks. During contractions, lean on your labor partner or a stationary object. Of course, it may not be possible for you to stand or walk if you've had an epidural and your legs are numbed or you're connected to a monitor and can't easily leave your bed. Most women use walking earlier in the course of labor, often before an epidural has been initiated.

Kneeling

If you're having a lot of back pain, kneeling on a pillow on the floor and leaning forward against your bed or a chair may feel good. This position relieves backache by directing the baby's weight away from your spine. Many birthing beds have two sections, one which can be lowered and the other which can be raised. The beds are designed so that you can kneel on the lower portion while resting your arms and upper body on the raised portion.

How you may be feeling

Transition may go quickly. You may suddenly be past it and ready to push. Or you may feel as if the pain is never going to end, and you're unsure whether you can hold on one more minute. Many women, especially those practicing natural childbirth, feel exhausted and somewhat overwhelmed during transition.

Don't worry if you lose control of your emotions. But to help you stay focused, try to remember the real reason you're there: to deliver and meet your new baby. And you're almost there! Your body was designed to give birth, and you're capable of making it through any tough times of labor. So let your uterus do its work and try not to fight or fear the pain.

Squatting

Squatting opens your pelvis a little wider, giving your baby more room to rotate as he or she moves through the birth canal. Squatting also allows you to bear down more effectively. If it feels right to you, squat on your bed or ask someone to support your weight as you lean on the bed or a chair and squat during contractions.

Sitting

During labor, you may want to sit up and have your labor partner sit behind you, supporting your weight. Or you may find it comfortable to straddle a chair, leaning against a pillow on the chair's back while your partner massages your back. Some centers have birthing stools, chairs or balls that allow you to sit during pushing and delivery. Find out what's available at your birthing center by talking with your childbirth class instructors or health care provider.

On your hands and knees

Don't be embarrassed to get down on your hands and knees during labor and delivery. Many women find this position comfortable. A hands-and-knees position allows your baby to fall forward during delivery, taking the pressure off your spine, which may help rotate the baby into a favorable position for birthing. Your health care provider may suggest this position to help maximize delivery of oxygen to your baby.

Lying on your side

Many women find it easiest to labor lying on their sides. Your partner can hold your upper leg, while you lie on your side and prop your head up with pillows. Lying on your side maximizes blood flow to your uterus and baby. This position also helps support the weight of your baby, which can ease back discomfort.

It's a good idea to discuss with your health care provider your preferences about positions for labor and childbirth, although you won't know what the best position is for you until you have a chance to experience it.

What you can do

During transition, concentrate on getting through each contraction. If it helps, focus on getting through just the first half of each contraction. After a contraction peaks, the second half gets easier. If your contractions are being monitored, your partner can watch their progress, letting you know when they've peaked so that you know when the hardest part is over.

During transition, you may not want things like radio or television distracting you. You may want to try some of the following techniques for making it through this challenging phase:

• Changing positions

• Placing a cool, damp cloth on your forehead

• Getting a massage between contractions

• Doing breathing, relaxation and focusing techniques learned in classes

Don't think about the contraction you just had or the contractions to come. Just take each one as it comes.

As difficult as transition can be, remember that it means you're almost finished. The average length of time for transition is about 15 minutes to three hours. Soon it will be time to push your baby out!

If you feel the urge to push, try to hold back until you've been told you're fully dilated. This will help prevent your cervix from tearing or swelling, which can delay delivery. It can be hard to resist this sensation when your body is telling you to bear down. To fight the urge to push, instead pant or blow, unless you've been instructed otherwise.

Stage 2: The birth of your baby

Pushing has a purpose, and you're actively involved in making it happen — the birth of your baby. Soon the top of your baby's head appears (crowns) at the opening of your vagina. Unfortunately, even though your partner and the health care team can see the baby when you push, it may take another 30 to 40 minutes of your effort to deliver the baby, especially if an incision (episiotomy) is to be avoided.

Occasionally, the baby needs to be delivered promptly and from this position. In such cases, an episiotomy can be made that will allow for more rapid delivery. Anesthesia will be provided for you if this procedure is necessary. In most cases, you'll be able to push the baby out without this intervention.

After you push the baby's head out, you'll probably be instructed to stop pushing for a moment while your health care provider clears the baby's airway and makes sure that the baby's umbilical cord is free.

You may find it difficult to stop pushing when told to, but try. It may help to pant instead of pushing. Slowing down gives your vaginal area time to stretch rather than tear. To stay motivated, you may be able to put your

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