Labor and birthing positions, stage by stage
Updated October 13, 2026 · sources checked October 13, 2026
In short
In the first stage of labor, upright positions such as walking, standing, sitting or kneeling were linked with a first stage about 1 hour 22 minutes shorter and fewer caesareans and epidurals in a Cochrane review. NICE recommends any position you find comfortable, except lying flat on your back, including with an epidural. For pushing, try kneeling, all fours, side-lying, sitting or squatting.
The one rule from the guidelines
NICE asks midwives to encourage and help you to move and adopt whatever positions you find most comfortable throughout labor, except lying flat on your back. ACOG agrees: frequent position changes for comfort can be supported as long as you and your baby can be monitored. Lying flat on your back has known downsides, including a drop in blood pressure and more changes in the baby's heart rate.
What the evidence found
| Stage | Review | Main finding |
|---|---|---|
| First stage (opening of the cervix) | Cochrane, 25 trials, 5,218 women (Lawrence et al., 2013) | Upright and walking positions: first stage about 1 hour 22 minutes shorter, fewer caesareans and fewer epidurals, with no sign of harm to mothers or babies |
| Second stage (pushing), without an epidural | Cochrane, 30 trials, 9,015 women (Gupta et al., 2017) | Upright positions: pushing about 6 minutes shorter, fewer episiotomies and assisted births, but more blood loss over 500 ml and possibly more second-degree tears |
Both reviews call for better trials, but the direction is consistent: moving and staying upright in the first stage helps, and in the second stage the choice is yours to discuss with your midwife.
Positions for early and active labor
- Walking and standing: the NHS suggests staying upright and gently active if labor starts during the day, to help your baby move down and your cervix open.
- Leaning forward: on a counter, the bed or your partner's shoulders, swaying your hips through each contraction.
- Sitting on a birth ball: gentle circles or rocking, leaning forward between contractions.
- Kneeling forward: over the bed back or a stack of pillows, which takes weight off your back.
- Side-lying: to rest without lying flat on your back, with a pillow between your knees.
- In water: a bath or pool can help you relax and make contractions feel less painful, according to the NHS.
Positions for pushing and birth
The NHS lists sitting, lying on your side, standing, kneeling and squatting, noting that squatting can be hard if you are not used to it.
| Position | When it may help | Things to know |
|---|---|---|
| Kneeling or all fours | Backache in labor (NHS) | Rest your upper body on the bed or a ball between pushes |
| Side-lying | Resting, or with an epidural | Your partner or midwife supports your top leg |
| Supported sitting or semi-upright | Comfortable for many, works with monitoring | Avoid sliding down flat onto your back |
| Squatting, birth stool | Uses gravity | Tiring; a bar, stool or partner helps |
| Standing | Early in the pushing stage | Hard to hold for long |
With an epidural
NICE recommends that women with an epidural use whatever positions they find comfortable, including upright, except lying flat on their back. If a midwife trained in epidural care confirms you have enough leg strength and sensation, you may be able to move with help, though your legs may feel heavy. Side-lying with pillows between your knees, or sitting upright in bed, are options to discuss with your midwife. Read more in our epidural guide.
For your partner or birth partner
- Be the support she leans on: shoulders to hang from when standing, a steady knee when kneeling.
- Give firm counter-pressure on the lower back during contractions if she wants it.
- Remind her to change position every so often and to empty her bladder.
- Help her move off her back if she slides down flat in bed.
Is this normal? When to call
Feeling the urge to change position often, or not wanting to move at all, is normal. Labor positions are about comfort, not performance.
At home in labor, call your maternity unit or OB-GYN straight away if your waters break, you bleed, your baby moves less or the pain is constant with no break. If the baby is coming now, call 911 (US) or 999 (UK); in the UK, NHS 111 if you cannot reach your unit.
Practise before the day
The NHS suggests trying these positions before labor and talking them through with your birth partner, so they know how to help. Write the ones you like in your birth plan, and keep moving between contractions while you time them with our contraction guide.
Any position is fine if you and your baby are well. If your midwife or doctor asks you to change position, for monitoring or for your baby's heart rate, they will explain why.
Questions parents ask
What is the fastest position to give birth in?
No single position is right for everyone, and ACOG notes there is little evidence that any one is superior. A Cochrane review found upright positions shortened the pushing stage by only about 6 minutes on average, mainly in first births.
Why should I avoid lying flat on my back?
ACOG explains that lying on your back in labor can lower your blood pressure and is linked with more changes in the baby's heart rate. NICE recommends any comfortable position except lying flat on your back.
Can I change position with an epidural?
Yes. NICE recommends that women with an epidural use whatever positions they find comfortable, including upright ones, except lying flat. If your leg strength is confirmed by your midwife, you may be able to move with help.
Which position helps with back pain in labor?
The NHS suggests that kneeling on all fours may help if you have had a lot of backache in labor. Counter-pressure on the lower back from your birth partner can also help.
Sources
- NICE NG235 — Intrapartum care, position and mobilisation checked October 13, 2026
- NHS — The stages of labour and birth checked October 13, 2026
- ACOG Committee Opinion 766 — Approaches to Limit Intervention During Labor and Birth checked October 13, 2026
- Lawrence A et al. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev 2013 (PMID 24105444, DOI 10.1002/14651858.CD003934.pub4) checked October 13, 2026
- Gupta JK et al. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2017 (PMID 28539008, DOI 10.1002/14651858.CD002006.pub4) checked October 13, 2026
Mamavela explains; it does not replace your midwife, doctor or pediatrician, who know your situation. If something worries you, call them. In an emergency, call 911 (US), 999 (UK) or 112.