At 37 weeks, the positions page of a birth plan can read like a yoga class you never signed up for. You're allowed to move in labor, and in a low-risk labor the World Health Organization recommends that your care team encourage it.
This guide covers eight labor positions in Bloom's order, then pushing, tearing and labor speed, including where the evidence runs thin. Once you know what you'd like to try, add your labor positions to your birth plan.
Moving and staying upright is recommended in a low-risk labor (WHO), and ACOG supports position changes as long as you and your baby can still be monitored. For the birth, WHO recommends the position you choose, with or without an epidural, within what your monitoring and care team allow.
Key Takeaways
- Upright and moving went with a first stage about 1 hour and 22 minutes shorter in a 2013 Cochrane review of mixed-quality trials.
- No single position is best, according to ACOG.
- Monitoring and epidurals shape your options, so ask what your unit can offer.
- Upright birth may bring fewer episiotomies but more second-degree tears (WHO, 2018).
Why Labor Positions Matter
The WHO's 2018 guideline on care in labor recommends encouraging mobility and upright positions in a low-risk labor (Recommendation 25).
ACOG's Committee Opinion 766, reaffirmed in 2025, links lying flat on your back to low blood pressure in the mother and more dips in the baby's heart rate. It finds little evidence that any one position is best, and says that for most people none needs to be mandated or forbidden.
8 Labor Positions to Try
Bloom's positions step lists these eight; tick as many as you like. Quoted descriptions are Bloom's own.
Standing or Upright
Bloom: "Upright with support from a partner or bar." Standing and walking are among the upright positions the first-stage research compares with lying down, and the NHS lists standing for the birth too.
Needs: a partner, the bed, a wall or a bar to lean on. Monitoring: belts can limit how far you move (NHS), so ask about wireless monitoring. Epidural: only if your legs stay strong; the NHS says some hospitals offer "mobile" epidurals that let you walk.
Kneeling
Bloom: "On knees, leaning forward over a support." The NHS suggests kneeling, walking or rocking to cope with contractions, and lists kneeling for the birth.
Needs: the raised head of the bed, a birth ball or your partner to lean over. Monitoring: ask your team whether yours allows it. Epidural: supported kneeling was among the positions in the epidural trials WHO reviewed, if your legs allow.
On All Fours
Bloom: "Hands and knees position." The NHS says kneeling on all fours may help for the birth if you've had lots of backache; see back labor positions. WHO suggests that anyone hoping for an upright birth might move to all fours or semi-reclined just before the baby is born, so the midwife can support the perineum.
Needs: the bed or a mat, and pillows. Monitoring: ask your team whether yours allows it. Research caveat: the reviews disagree on whether all fours counts as upright, so trial results map loosely onto it.
Birthing Stool or Squat Bar
Bloom: "Sitting upright on a stool or using a squat bar." A birthing stool is a low seat with an open middle for sitting upright to push, and a squat bar gives you something to hold while you squat. In the Cochrane review behind WHO's recommendation, 10 trials tested a birthing or squat stool against lying positions. The NHS warns that squatting may be hard if you're not used to it. A Swedish study described by WHO linked squatting and birth seats with more severe tears in women who had given birth before (observational, so not proof of cause).
Needs: a stool or bar, which your unit may not have, so ask on your tour. Epidural: squatting with a bar appeared in the epidural trials WHO reviewed, but it takes leg strength.
Side-Lying
Bloom: "On my side, often with a pillow between the knees." The NHS lists it for the birth, and it's the one position a study described by WHO linked with fewer severe tears in first-time mothers (more below).
Needs: pillows, and someone to hold your top leg while you push. Monitoring: ask your team whether yours allows it. Epidural: used in WHO's epidural trials; ask your team.
Semi-Reclined, Including the "Throne" Position
Bloom: "Propped up in bed with back support." "Throne position" is a common nickname for sitting upright in a bed raised like a chair, and you won't find it in WHO or ACOG guidance. In the epidural trials WHO reviewed, reclining 45 degrees or more from flat counted as upright, and anything flatter counted as lying down. No source we used tests the throne setup on its own.
Needs: an adjustable bed and pillows. Monitoring: ask your team whether yours allows it. Epidural: used in WHO's epidural trials; ask your team. ACOG links lying flat with downsides, though no one position needs to be mandated.
Water Birth
Bloom: "Giving birth in a tub if available." The NHS says water can help you relax and make contractions seem less painful, with pools kept no warmer than 37.5°C (99.5°F). ACOG says laboring in water may be offered in the first stage to healthy people with uncomplicated pregnancies, but recommends birth on land, so ask whether your hospital offers a tub.
Open to Suggestions
Bloom: "I'd like my care team to guide me." The NHS says your midwife will help you find a comfortable position, and WHO says that if your position has to change for monitoring, the reason should be explained to you. Questions to ask:
- Which positions work with the monitoring I'll have?
- Do you have a birth ball, peanut ball, squat bar or birthing stool?
- Which pushing position do you suggest, and can I try others?
Labor Positions in a Hospital Bed
ACOG says you may need to stay in bed with electronic fetal monitoring, but you can move around and find a comfortable position. The NHS says monitor belts can restrict movement, while a handheld check every 15 minutes leaves you free to move.
On the bed, you might try side-lying, semi-reclined, kneeling over the raised head of the bed or all fours; ask which your monitoring allows. ACOG says intermittent listening, an option in low-risk labors, can allow freedom of movement. Its description of low risk generally excludes a previous cesarean scar, so if you're planning a labor after a cesarean, read about positions during a TOLAC.
Positions If You Have an Epidural
WHO recommends encouraging a birth position of your choice with an epidural too. Our guide to positions with an epidural and the peanut ball has the details, and epidural pros and cons covers the decision itself.
Tick the positions you want to try in Bloom. They appear under "Positions" in your plan, which you can download as a PDF or email to your care team. Choose your positions in Bloom.
Pushing Positions and How to Push During Labor
WHO recommends encouraging the birth position you choose, upright included, with or without an epidural (Recommendations 34 and 35). The NHS lists sitting, lying on your side, standing, kneeling and squatting, and suggests practicing before labor.
WHO also recommends that you follow your own urge to push (Recommendation 36). ACOG notes that people who aren't coached tend to push with an open throat (an open glottis) rather than holding their breath, and the limited evidence favors neither style, so use what works for you. The NHS says you may not feel the urge at all with an epidural, and expects this stage to last no more than 3 hours with a first baby and 2 hours otherwise. Ask what your hospital expects.
With an epidural, the guidance on timing differs. WHO recommends waiting one to two hours after full dilation, or until the urge returns, where resources allow. ACOG says the data support pushing at the start for first-time parents, and says the risks of waiting (infection, heavy bleeding, acid buildup in the newborn's blood) should be shared with you. Ask your team which approach they use.
What Is the Best Position to Give Birth to Avoid Tearing?
No source we used names one. In WHO's 2018 summary of the Cochrane evidence, upright birth without an epidural may mean fewer episiotomies (about 101 fewer per 1,000 births) but more second-degree tears (about 25 more per 1,000) and more blood loss over 500 mL (about 21 more per 1,000).
WHO also describes a Swedish study of 113,000 women. It linked lying on your back with your legs in stirrups to more anal sphincter injuries, side-lying to fewer in first-time mothers, squatting and birth seats to more of them in women who had given birth before, and kneeling, standing or all fours to no clear difference. An observational study like this can't prove cause.
WHO recommends perineal massage, warm compresses and hands-on support in the pushing stage (Recommendation 38). The NHS adds that your midwife may ask you to stop pushing and pant as the head appears, so the skin has time to stretch. Ask your provider which of these they offer.
Do Labor Positions Speed Up Labor?
Possibly, in the first stage. A 2013 Cochrane review of 25 trials found the first stage about 1 hour and 22 minutes shorter for women who were upright or walking, and they were less likely to have a cesarean or an epidural. The trials were of variable quality, and WHO notes the effects did not appear among women who already had an epidural.
The NHS advises staying upright and gently active if early labor starts in the daytime, saying it helps your baby move down and your cervix open. For pushing, the Cochrane review on birth position found upright positions cut pushing time by around six minutes, from very low-quality evidence. None of these sources promises a faster labor.
Labor and Birthing Positions at a Glance
| Position | Stage | Needs | Continuous monitoring | Epidural |
|---|---|---|---|---|
| Standing or upright | First stage; birth | Something to lean on | Ask about wireless | Only with strong legs ("mobile" epidural) |
| Kneeling | Both stages | Bed head, ball or partner | Ask your team | If your legs allow |
| On all fours | Backache; birth | Bed or mat, pillows | Ask your team | Ask your team |
| Birthing stool or squat bar | Pushing; see the tearing section | Stool or bar | Ask your team | Needs leg strength |
| Side-lying | Rest; birth | Pillows, leg support | Ask your team | Used in WHO's epidural trials; ask your team |
| Semi-reclined or throne | Rest; pushing | Adjustable bed | Ask your team | Used in WHO's epidural trials; ask your team |
| Water birth | Labor; birth if offered | Tub or pool | Ask your team | Ask your team |
| Open to suggestions | Any | Your nurse or midwife | Your team guides | Your team guides |
Labor Positions With a Partner
The NHS suggests talking to your birth partner so they know how to help, and ACOG describes a trial of 600 first-time mothers in which teaching a friend or relative labor-support techniques went with shorter labors. Ideas to try (ours; no trial tests them):
- Standing: be the post you lean on.
- Kneeling: sit in front so you can rest your arms on their lap.
- On all fours: press on your lower back or hips.
- Side-lying: hold your top leg during pushes, if your nurse asks.
Bloom's support step has a "Names and roles" box for who does what, and our guide to who can be in the room with you covers hospital rules.
How to Write Labor Positions Into Your Birth Plan
The positions you tick in Bloom show up under "Positions" in your plan. Put anything more specific in the Special wishes box at the end. Lines to adapt:
- "I'd like to move freely and try upright positions."
- "If I have an epidural, please help me change sides regularly."
- "Please offer warm compresses and perineal support as the baby's head is born."
- "If my position needs to change for monitoring, please tell me why."
Our birth plan examples show complete plans. When your list is ready, build your birth plan in Bloom.
Frequently Asked Questions
What are the best labor positions?
No single position is best, according to ACOG. WHO recommends moving and staying upright in a low-risk labor, then giving birth in the position you choose. Try several and change when you need to.
Can I move around in labor if I'm being monitored?
Within limits. ACOG says you may need to stay in bed with electronic monitoring but can still move and find a comfortable position. Ask your team which positions your monitoring allows.
What is the throne position in labor?
It's a common nickname for sitting upright in a hospital bed raised like a chair. It isn't in WHO or ACOG guidance, and no source we used tests it, so no benefit is proven.
What is the best position to push?
The one that works for you. WHO recommends encouraging the birth position you choose, with or without an epidural, and following your own urge to push.
Which birth position helps avoid tearing?
No source we used names one. Upright birth without an epidural may mean fewer episiotomies but more second-degree tears (WHO, 2018). Ask your provider about perineal massage and warm compresses.
Do labor positions speed up labor?
Possibly, in the first stage. A 2013 Cochrane review of mixed-quality trials found it about 1 hour and 22 minutes shorter for people upright or walking. Pushing time differed by about six minutes, on very low-quality evidence.
This article is for information only and does not replace medical advice from your OB or midwife.
How This Guide Was Made
The Babysential Team wrote this guide from the WHO, ACOG, NHS and Cochrane documents below, checked on October 9, 2026, with AI-assisted drafting; our own suggestions are marked as ours.
Sources
- WHO recommendations: intrapartum care for a positive childbirth experience. WHO, 2018
- Approaches to Limit Intervention During Labor and Birth, Committee Opinion No. 766. ACOG, 2019, reaffirmed 2025
- Fetal Heart Rate Monitoring During Labor. ACOG, last reviewed 2026
- Immersion in Water During Labor and Delivery, Committee Opinion No. 679. ACOG, 2016
- The stages of labour and birth. NHS, 2023
- Pain relief in labour. NHS, 2023
- Episiotomy and perineal tears. NHS, 2023
- Maternal positions and mobility during first stage labour. Lawrence et al., Cochrane, 2013
- Position in the second stage of labour for women without epidural anaesthesia. Gupta et al., Cochrane, 2017
