Positions for Pushing

After a few recent births where pushing went a little less smoothly, I’d like to talk about the 2nd stage of labor, what to expect and how to advocate for yourself. This post is by no means a hard and fast guide for how you should push, but rather a discussion of how you can push. I want to expand your horizons of what’s possible, even if those possibilities aren’t offered to you in the hospital.


Although evidence shows that pushing in upright positions shortens labor and prevents instrumental or Cesarean birth, many hospitals and providers, including the ones in my area, have folks give birth on their back or in a semi-sitting position. Though many providers and nurses do not force birthing people to push in this position, they often don’t suggest other positions or don’t encourage trying something different. I want to emphasize that there are definitely other options! If pushing on your back or in a semi-sitting position worked or works for you, go for it! I’ve seen babies that were moving slowly pop right under the pubic bone when their parent tried pushing on their back! Go with what works for you!


But let’s break down why other positions might be a great option. If you think about your pelvis, you might think of it as one continuous ring of bone, but it’s actually many bones joined together with connective tissues. This allows for a surprising amount of movement, especially during pregnancy when hormones soften and stretch all those connective tissues. To take advantage of that flexibility and make as much room for your baby as possible, try positions that don’t limit movement of the pelvis. If you lie on your back, you’re closing off the whole back of your pelvis. In contrast, pushing on hands-and-knees allows all parts of your pelvis to open and stretch for your baby. Even lying on your side allows more movement in your pelvis.


Gravity is another thing that makes upright positions so helpful. Instead of fighting against physics, allow gravity to help you bring your baby down! Your uterus also works more effectively when it’s not fighting against gravity, making your contractions more effective and less painful. This is true of the 1st stage of labor as well!


So how do you make this happen during the throes of labor? How do you ask for what you want if what’s being offered isn’t working for you? Well, reading this post was a good start. Education is the best first step in advocating for yourself. Next, think about what you’d like to try. And communicate those preferences to your support team, so they can help remind you and encourage you. You can include your preferences on your birth plan or birth preferences form too.


Here are a few other positions to try if you’d like some other options:


Hands-and-knees


As I mentioned before, hands-and-knees opens up the pelvis and allows your baby to move more easily through. Birth people often spontaneously choose to push on hands-and-knees if given the option.


Sitting on the toilet


Not only does sitting on the toilet help gravity bring your baby down, but it also makes it easier to relax your pelvic floor. Some birthing folks have difficulty coordinating pushing and letting go, but sitting on the toilet helps make that mind/body connection.





Semi-sitting with towels rolled up under your sitz bones


The biggest issue with sitting on the bed is that it closes off the pelvis, but you can solve that problem by propping yourself up to bring your pelvis off the bed. Use towels or yoga blocks to create this space.


Standing


Gravity is your friend! You can lean on a counter or bed or even your partner to get some rest in between.


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