If you are doing your best to go without an epidural during your birthing experience, then different birthing positions will be a crucial part of your laboring.
Switching positions about every hour is recommended, but more frequently works as well. I always tell clients to have some ideas of different positions before they go into labor so that they are not thinking on the fly. The good news is, if you hire a doula or a midwife, they will be great at encouraging position changes and giving ideas on good positions that might help bring your baby sooner.
I have seen people labor and birth in many different positions, but these are some of my favorite ones.
Hands and Knees
Whether on your hands and knees in a birthing pool, bed, or the floor, this position can be super helpful and comfortable during labor. I often see birthing individuals use this position and then rock their bodies to move their baby down. Hundreds of thousands of babies have been born in this position, and there will be more to come.
Another way to do hands and knees is by leaning over a birthing ball or pile of pillows. If you are in the hospital, they can move the bed into a good position for you to be on hands and knees leaning over the back of the hospital bed. These versions of hands and knees can give your arms a rest and still provide the same level of comfort.
Many of my birthing parents that I serve enjoy having counter pressure and hip squeezes while in this position or using a tens unit to help with back labor. Hands and knees facilitate it all. Another plus to this position is that many who get the epidural still have enough feeling in their legs to try this position out. It might be the way you bring your little one into this world, pain medication or not.
Side-lying
Side-lying is a great position when a birthing person is exhausted and needs some rest in between contractions. Stacking a bunch of pillows between the legs or putting a peanut ball between the legs is a great way to continue dilation and progress while allowing your body to physically and, in some cases, mentally rest.
This is also a great position if your baby is in a wonky position. You might consider doing an extended side-lying position where you are almost lying on your belly with your leg hanging over the edge of the bed. Most of the time, this is the only position we need to utilize to move a mispositioned baby. This is another position that can be achieved with an epidural, and quite frankly, it is easier to push in than being on your back. It is also a great way to make sure the epidural moves evenly throughout your body. Just make sure you are switching sides every 5-10 contractions.
Supported Squat
The supported squat is great because, well, there is support. Squatting through contractions without support can be a lot, especially on your legs, but squatting with some sort of support is a good alternative. This can look like squatting with your partner holding you up, utilizing a rebozo over a door to hold your weight, and even placing bolsters under your sits bones while in a squatted position, which is helpful. Supported squatting is a fantastic way to help with getting your baby engaged in the pelvis, as well as a powerful way to push and birth your baby.
Toilet or Birth Stool
Along the lines of a supported squat is an even more supported squat/seated position on the toilet, a birth stool, or a makeshift birth stool with bolsters under your sitz bones. We often call the toilet the "dilation station" because our pelvic floors are programmed to relax while on the toilet, and a relaxed pelvic floor aids in dilation. This position can be used for pushing, but if you are anxious about tearing, I would not recommend it as much. I most commonly see tears in individuals who birth in this position.
Standing Up/Slow Dancing
Standing up and leaning onto a partner, doula, bookshelf, etc., can be another great way to work through contractions. I often see couples slowly dancing through big waves, and I have even seen a few individuals birth upright. I love the closeness that the slow dance can bring for couples during labor, and I also love how gravity helps bring babies down.
This is an excellent position and one we often see utilized between positions when you don't quite have time to get where you are headed.
Captain Morgan
This position is where you have one knee down and pop your other knee up with your foot planted on the floor. We like to call it Captain Morgan; surprisingly enough, many get our reference. This is a great position to use when a baby is working on positioning. It can also really open the hips and allow the baby to come down with the added help of extra space. Usually, like the side-lying position, our clients change which leg is popped up every few contractions if not every other contraction. This helps ensure that whichever side the baby needs a bit more space on, they get it.
Supine
Although there are many other positions we could talk about, the last one I will highlight is the supine position, or laying on your back. Although doulas and childbirth educators have somewhat demonized this position, it can be a beneficial position for some.
I completely agree that this position should not be the assumed position for all births, but in some cases, it is the best way to get a baby out. Most of my clients with tilted uterus' prefer the supine position. It is also helpful if you're trying to get a big baby out, especially pulling your knees back toward your head in the McRoberts position, the first position used to resolve shoulder dystocia. Other reasons for this position would be exhaustion, an epidural that worked a little too well, and comfort.
My best recommendation leading up to labor is to try each of these positions out so that you know what they look and feel like. Listen to your body as you go into labor; it knows how to move and which positions to go to. Remember to try to switch positions every hour or so, but if you have something you like and it is working, it is okay to stick with it. Different birthing positions can bring relief and more intensity. Remember that most of the time, the most intense positions are needed to bring your baby into your arms.
