Push Positions During Labor and Delivery
There are many options for pushing positions when you are in labor! When the time comes to push, most OBs and nurses will call the shots. They will instruct the mother to get on her back on the bed and assist her in holding her legs back. They will likely coach her, telling her when, how long, and how to push. Directed pushing not only discourages the mother from listening to her instincts but can also increase her fear and anxiety, causing her to lose focus and experience increased pain. Directed pushing can also strain mom and baby because mom is holding her breath, not properly getting oxygen to baby, and pushing as hard as she can to get baby out forcefully. The best way to push is by listening to your body to find a comfortable position. Push with your body, not with someone else’s instruction. Additionally, research has shown that a mother laboring on her back can lengthen labor time and increase the chances of using forceps, vacuum, and many other interventions.
Traditionally moms are told to lay on their backs on the bed while pushing. Research has shown that laying on your back is counteractive to the goal you are trying to reach, which is getting the baby out. Laying on your back works against gravity and the natural reflex a mom has called the “Fetal Ejection Reflex.” The Fetal Ejection Reflex works with your contractions and moves the baby through the birth canal without pushing. Birthing on your back can also put pressure on your tailbone, which creates a smaller and less flexible exit for the baby. Upright birthing positions work with gravity and your Fetal Expulsion Reflex to gently move the baby through the birth canal. Upright birthing positions also provide a better oxygen supply to the baby and lead to a more positive birth experience.
What if you are planning to get an epidural? There are still options! You can still push in different positions, even with an epidural and limited movement. Other positions during labor, even with an epidural, can shorten the length of the second stage of labor, decrease the chance of needing artificial oxytocin (Pitocin), and lead to fewer episiotomies and greater satisfaction. If you are planning an epidural, you can always ask for a lesser dose, so when it comes time to push, you can feel all the sensations of pushing without the fear of pain. It encourages mom to listen to her body and not use directed pushing. As with any decision during pregnancy, you must weigh the risks and benefits yourself. Push positions are also a great topic to bring up with your OB/GYN or midwife, so they have a heads-up on your labor plan. Your OB/GYN or midwife should be very open to your wishes during labor.
If you want more control during your labor and want to try different push positions, here is a list of different positions you can try:
Standing: your partner or doula should support some of your body weight and wrap your hands around the base of their neck. Standing allows the mom to lean forward or sway her pelvis to help the baby rotate.
Kneeling: in this position, your partner or doula can provide light massage, counterpressure, or other comfort measures. Kneeling also allows the mom to lean forward, sway, or tilt the pelvis to help the baby rotate.
Lunging/raising one leg: lunging on a chair, on the ground, or kneeling on one leg stretches the pelvis open on one side more than the other. Switching legs after a few minutes will help the baby engage in the pelvis and through the birth canal. This position is also great for malpositioned babies. Opening one side of the pelvis more than the other can get the baby to rotate into the correct position for delivery.
Squatting: squatting should always be supported by your partner or doula, or someone should be close in case mom’s legs tire. It can also be done on the bed with a squat bar to provide more comfort. Squatting helps open the bottom of the pelvis and creates an optimal birth environment. Mom should always lean back and rest in between contractions when squatting.
Side-lying: This position is ideal for moms who want an epidural. It is also an excellent option for mom to rest during labor but continue to make progress. Your partner or doula should support your mom’s leg and support her back to keep her from rolling over.
Semi-sitting: This position is different from supine because it uses more gravity. A partner can support you by sitting behind you and holding your body weight. You can also maneuver the bed in a hospital to a more upright position. This position can put pressure on the tailbone and push it inward.
All these positions work with gravity and your body’s ability to birth without intervention. You can modify these positions to fit mom’s comfort needs best. If you want to know more about push positions or have any questions, we are here to support your decisions and guide you every step of the way!