Search icon


28th Jun 2015

Get off the bed! Positions for labour and birth

Sylda Dwyer

When we see births on TV or in films the bed is usually the centre of all the action! We see women on their backs and usually with legs in stirrups. The reality is, unless you’ve had an epidural, the bed is the last place you should be. Often it’s the presence of the bed in the room in the first place that makes people – women, partner and healthcare providers – gravitate towards it. It’s there, so why wouldn’t you use it, right?

The bed in your delivery suite can be a great tool to support you, but not by lying on it! A 2013 Cochrane Review found that the first stage of labour, when your cervix is dilating from 0-10cm, may be approximately one hour and twenty minutes shorter for women who are upright or are walking around. It also found that when women who were upright and mobile during labour were compared to women who laboured lying down in a bed, their risk of Caesarean birth was reduced, they were less likely to use epidural as a method of pain relief and their babies had a lesser chance of being admitted to the neonatal unit.

Another Cochrane Review recommended that women should be encouraged to give birth in comfortable positions, which are usually upright. It found that women who give birth on their backs were more likely to have an instrumental delivery using forceps or vacuum, and were more likely to require an episiotomy but had less blood loss.

So the evidence shows that for both labouring and giving birth, being upright and mobile is preferable for improved outcomes for both mothers and babies.

Now that we’ve looked at the science, what about what feels good?

When labour begins naturally and women are progressing well at their own pace and without intervention, they usually find that their body adopts the position they find most comfortable all by itself. Some women find that they really like being on all fours, or sitting on their birth ball. Others like to walk around or use the bed to lean forward on if they are kneeling, for example.

Many women love being in water, either in a birth pool, a deep bath or a shower. If you are feeling comfortable and safe, with all that lovely oxytocin flowing in your body, you will find you will instinctually move into positions that work best for you. This applies not only when you are labouring but also when you are delivering your baby. You might find the very last place you want to be is on your back.

When you’re lying on your back, your baby has to travel uphill to make their way through the birth canal. When you’re in an upright position, you’re working with gravity to help your baby move down and also giving them plenty of space to do it.

So what are the best positions to use?

Only you will know yourself when labour begins. You might like the idea of a few positions and then discover on the day that you’d actually prefer something completely different! The National Childbirth Trust (NCT) in the UK have produced some excellent posters to give you some ideas to try.

It’s also a good idea to include a sentence in your birth preferences along the lines of “I prefer to labour and birth in any position I find comfortable”. This will help your midwife on the day know the type of birth that you have prepared for and she will be able to support you as you try different positions during your labour and birth.

Have a chat with them about what tools might be available in the delivery suite for you to use. Perhaps they have yoga mats to support your knees or maybe you might need to bring in your own birth ball. Some maternity units will also have birth stools and maybe this is something you’d like to try. Absolutely you can use the bed in delivery suite, just make sure it’s working for you and not the other way around!

Sylda Dwyer is a GentleBirth birth preparation instructor and Doula. She teaches workshops in Dublin and provides support and advice to women and their partners in pregnancy, birth and early parenting. For more, find her at AlphaBirth or catch up with her at @birth_rocks.