What’s the best position for labor?

It’s a simple answer: (when unmedicated) the position you choose.

We hear so many birth workers shouting from the rooftops (and TikTok) “don’t labor on your back!”

But what if being on your back is what feels best? Sometimes that's the position your body needs.

What these birth workers should be saying is “Labor in the position that feels best AND is working.”

Where did all of this talk come from? When labor and birth moved into the hospital, medical doctors were trained to “deliver” babies with women (and later mannequins) on their backs. This is what they know.

I have literally heard several doctors say, “When someone is on their hands and knees, everything is backwards and I don’t know how to catch the baby.”

The other thing we need to to point out is “laboring” and “birthing” (or “delivering”) are two different stages.

When we are laboring, our baby is in the uterus and we are experiencing contractions that are helping our cervix to change: to open and thin (or “efface’). When we are birthing (or delivering), we are pushing the baby through the birth canal (or the vagina).

Most people are not comfortable laboring on their back. In fact, in the hundreds of births I’ve personally witnessed in real life, no one has ever felt good on their back during a contraction. That is, unless they had an epidural (which numbs the body from basically the bra-line down). But some people do choose to birth, or push, on their back. If someone has chosen to labor on their back, we should probably honor that and not ask (and never force) them to move.

Laboring and pushing with an epidural does change the conversation a little. When you’re anesthetized, you cannot feel the messages your body is sending re: best position. Any position is a go - as long as the fetus is happy with it (which we can kind of tell via the info an external fetal heart rate monitor gives us). Sometimes, if the labor is long or gets a little “wonky” (a birthy word for “there’s nothing really wrong with this labor but it’s also not doing what we’d like") it can be a good idea to focus on specific positions that can encourage the baby into a different position - which will in turn help with dilation and descent.

Now, what if you’re on an epidural and you can’t feel the message your body sends telling you to labor on your back? Most providers and nurses these days will not suggest laboring on your back. They will keep you rotating side to side and then only suggest “lithotomy” once you start pushing. While this allows more access to the doctor, it can make pushing more difficult and increase the risk for complications, like instrument delivery (think forceps).

THIS is what we’ve been trying to encourage providers to stop doing.

And this is where the mantra “don’t labor on your back” has come from.

What we should be saying is “Don’t force people to labor in positions that are convenient for doctors.”