Extract

Pregnancy – Chapter 3

Labouring positions

Singleton pregnancy: start practising from week 34

Twins: start practising from week 31

From an anatomical point of view some positions allow more space for baby to move down. Ideally the sacrum (base of the spine) needs to slightly open backwards to maximise the size of the pelvic outlet and allow more space for your baby’s head. By contrast, lying on the back and raising the head when pushing will tighten the pelvic floor and tearing or/and an episiotomy are more likely. Midwives should suggest different positions to best manage t pushing stage and minimise trauma to your pelvic floor.

Some suggestions to help baby move downwards

  • Keep upright
  • Walk
  • Dance from one foot to the other
  • Squat
  • Partially squat with your forearms resting on the bed and your bottom sticking out
  • Do a hanging squat where you start upright and “hang off” a prop or your partner and slowly move down to a squatting position
  • In water, try to move the body weight forward by kneeling into an all-four position or squatting with one knee on the floor of the pool and the other foot flat

Depending on the position of the baby and on how well she’s progressing, midwives might suggest other positions such as lunging or kneeling forward.

If you need to rest, try the following

  • Sit on a birthing ball
  • Lie down on your left side
  • Use a birthing pool

I would recommend practising these different labouring positions with your birth partner a few times in late pregnancy. The Maternity Services Survey 2017 indicates that of women who had a vaginal birth without instruments 18% gave birth sitting or sitting supported by pillows, 6% lying on their side, 22% standing, squatting or kneeling, 28% lying flat or lying supported by pillows, 22% lying with their legs in stirrups and 4% in another position.

It also notes that there “has been a small but statistically significant increase of the group of women who gave birth while ‘lying with their legs in stirrups’ between 2015 (35%) and 2017 (36%).” However best practice guidance is to encourage women to move and adopt whatever positions they find most comfortable.