Working with individuals during pregnancy, we’re often asked, “What is the best position to deliver a baby in?” Our response is consistent: there is no one perfect position. Just like with posture, the best position is the one that keeps changing and allows you to feel most supported, safe, and in control. Birth is dynamic, and your positioning should be too.
When we look at the research, there’s compelling evidence to suggest that movement, variety in labor positions, and a sense of autonomy all contribute to better outcomes in labor. These benefits include reduced pain, improved fetal positioning, and a decreased need for medical interventions such as Cesarean sections, vacuum-assisted deliveries, or the use of forceps. One cohort study out of Italy by Gizzo et al. (2014) followed 225 first-time pregnant individuals, all carrying a single, head-down baby. The participants were split into two groups: those who labored more than 50% of the time in recumbent positions (on their back or side), and those who spent the majority of labor in alternative, upright or active positions (such as squatting, hands and knees, or using a birth ball). The results were striking—those in the alternative positions group had significantly higher rates of spontaneous vaginal deliveries (87.1% compared to 47.8%), lower rates of assisted deliveries (7.1% compared to 26.1%), and shorter labor duration overall.
Hands and Knees Position
This is one of the most beneficial positions for reducing back pain during labor and encouraging a baby to rotate into an optimal head-down, anterior position. It opens the pelvic inlet and allows the sacrum to move freely, which may ease pressure and shorten labor. This position is especially helpful when the baby is in a posterior position (facing the front of the parent’s body), which can lead to longer and more painful labors.
Sidelying WIth A Peanut Ball Between The Legs
This position is particularly helpful for individuals who need to rest or who have received an epidural. The peanut ball helps keep the pelvis open and encourages descent of the baby by promoting internal rotation. Alternating sides periodically can promote balanced engagement and minimize prolonged labor. It’s a supported, restful, and research-backed option for continuing labor progress without active movement.
Why Hip Internal Rotation Matters in Labor
Internal rotation of the hips is a key biomechanical factor in helping the baby descend into and through the pelvis, especially in the later stages of labor. Positions that promote internal rotation —such as sidelying with a peanut ball, a supported squat with knees slightly turned in, or certain hands-and-knees adaptations—help widen the pelvic outlet and create space for the baby to navigate the birth canal. Limited hip internal rotation can restrict pelvic mobility and may slow labor progress. Encouraging gentle movements and positions that bias internal rotation during labor may improve outcomes and reduce the need for interventions.
Let’s break down a few of these alternative positions that can be especially effective during labor:
Squatting or Supported Squat Using a Partner or Bar
Squatting widens the pelvic outlet by up to 30%, which can help facilitate baby’s descent. This position uses gravity effectively and is often helpful during the pushing phase. A squat bar or birth partner can provide the support needed to maintain this position, especially when fatigued.
Sitting in a Bathtub
Sitting in a warm bathtub during labor—also known as hydrotherapy—can be incredibly soothing and effective for managing contractions. The warmth of the water promotes relaxation of the pelvic floor muscles, which may help facilitate cervical dilation and the baby’s descent. It also reduces tension in the body and supports a calmer, more focused labor experience. The
buoyancy of the water eases pressure on the joints and lower back, allowing for easier movement and position changes while providing a supported upright posture. This position is especially beneficial for those who want to remain vertical but also desire rest and relief. Leaning forward onto the edge of the tub or resting against the sides can enhance comfort, and for many, the water’s calming effect helps reduce the perception of pain and supports the body’s natural rhythm during labor.
Standing or Leaning Forward onto a Partner or Bed
An upright stance uses gravity to encourage descent, while leaning forward provides a break for the back and allows the pelvis to tilt into a more open angle. This position is also useful for those experiencing intense back labor or who need continuous support.
A 2019 systematic review by Berta et al., published in BMC Pregnancy and Childbirth, examined the effects of upright positions during the second stage of labor—the pushing phase. The researchers concluded that upright or “flexible sacrum” positions (those that don’t restrict the movement of the sacrum, such as being off your back) can significantly shorten this phase. Importantly, they emphasized that every laboring person should be encouraged to find and use positions that feel most comfortable to them.
More recently, a 2022 Cochrane Review by Gupta et al. reinforced these findings. It showed that upright and mobile positions during the first stage of labor decreased overall labor duration, reduced the likelihood of needing an epidural, and improved satisfaction with the birthing experience. Similarly, in 2023, the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion supporting movement and positional changes during labor. They acknowledged that lying flat on the back may increase discomfort and the need for instrumental delivery.
All of this evidence points toward a single truth: laboring individuals benefit from choice, movement, and support. While there is no universal “best” position, many positions offer specific benefits based on the stage of labor, the baby’s position, and the comfort of the birthing person. What matters most is that you feel empowered to move, to rest, and to find what works best for your body in each moment.
Ultimately, the best position is the one where you feel the most safe, relaxed, and capable. Surround yourself with a supportive healthcare team that honors your choices, provides you with options, and encourages movement throughout the birth process. Your body knows how to birth —and the right position is the one that honors that wisdom.
At Mend, we offer intrapartum physical therapy services designed to support you in both the prenatal and labor preparation phases. We encourage patients to begin care after the first trimester to optimize pelvic health, manage pregnancy-related discomfort, and prepare for an empowered, informed birthing experience. Whether you’re just getting started or continuing your training during pregnancy, our team is here to guide you with individualized, evidence-based care.