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Is it safe? · Pregnancy Smart

Is pushing positions during labor safe during pregnancy?

Assigned clinical reviewerMichael Yuzefovich· MD, FACOGDraft · pending clinical reviewUpdated

What does the evidence say about pushing positions during labor during pregnancy?

  1. ACOG supports frequent position changes for comfort and fetal positioning when the chosen posture permits appropriate maternal and fetal monitoring and needed interventions. It also supports each laboring person using a preferred and effective pushing technique because data do not establish one superior breathing method. 1
  2. A meta-analysis of five randomized trials involving 3,368 term participants found that hands-and-knees positioning did not increase occiput-anterior fetal position at delivery compared with control positions. A post hoc malposition subgroup showed a temporary positional difference that did not persist at birth. 2
  3. A Cochrane review of 30 trials with 9,015 participants without epidurals associated upright positions with fewer assisted births and episiotomies but more blood loss above 500 mL and possibly more second-degree tears. Trial bias and heterogeneity make the tradeoffs uncertain. 3
  4. The BUMPES randomized trial enrolled 3,236 first-time mothers at term with effective epidurals. Spontaneous vaginal birth occurred significantly less often under an upright-position policy than a side-lying policy, 35.2% versus 41.1%, while most secondary maternal and newborn outcomes did not differ. 4
  5. A Cochrane review of pushing methods found no clear advantage of coached over spontaneous pushing for major birth outcomes. Evidence ranged from moderate to very low quality, with high heterogeneity, supporting comfort-responsive coaching rather than one mandatory breath-holding method. 5

Is pushing positions during labor safe in each trimester?

  • First trimester. Pushing position is a delivery-stage choice, not an early-pregnancy exercise prescription. If mobility limitations, hip disease, neurologic conditions, or prior pelvic injury may matter, document them early for later physical and anesthesia planning.
  • Second trimester. Childbirth education can help you try side-lying, hands-and-knees, supported squat, kneeling, semi-reclined, or upright postures without promising a single best option. Ask which positions the planned unit can support with its beds, bars, monitors, and staffing.
  • Third trimester. Share preferences while keeping flexibility for epidural density, fetal position, comfort, blood pressure, fetal monitoring, operative assistance, and rapid change. Frequent position changes are reasonable when maternal and fetal status remain reassuring.

Frequently asked questions

What is the best position to push during labor?

There is no best position for everyone. Without an epidural, upright or lateral choices can be reasonable. With an epidural, the largest position trial in first-time mothers found more spontaneous vaginal births under a side-lying policy than an upright policy. Comfort, progress, and monitoring matter.

Which pushing positions count as upright?

Upright positions include sitting, supported squatting, kneeling, standing, or using a birth stool or bar. Hands-and-knees can shift pelvic pressure but is not always classified identically across studies, which is one reason broad upright comparisons are difficult to apply.

Is side-lying a useful pushing position?

Side-lying is a flexible supported position that can preserve access for monitoring and work with an epidural. It may be easier when legs feel heavy or blood pressure falls. No evidence shows it is universally superior, but comfort and safe access make it a practical option.

Can I squat while pushing with an epidural?

Possibly, but only with adequate leg control, support, staff assistance, and safe monitoring. Dense numbness can make weight-bearing unsafe. A supported squat, side-lying posture, or repositioned bed may offer similar pelvic flexibility without an unsupported fall risk.

Why did lying down perform better in the epidural trial?

BUMPES found more spontaneous vaginal births with a side-lying policy, but it did not establish the mechanism. Lying down meant the left or right side, with limited bed inclination, rather than lying flat on the back. The finding applies most directly to first-time mothers at term with effective epidurals.

Do upright positions shorten pushing without an epidural?

The Cochrane review found an average second-stage reduction of about six minutes, but study results varied greatly and the duration evidence was very low quality. Upright positions were also linked to fewer assisted births and more blood loss above 500 mL, so no single benefit should be isolated.

Should I hold my breath and count to ten while pushing?

Not routinely. Comparative evidence does not establish coached prolonged breath-holding as superior to following the urge to push. ACOG supports the person's preferred effective method, while the team may give focused coaching if an epidural limits sensation or a specific clinical need arises.

Can I change positions during the pushing stage?

Yes, when maternal and fetal status, monitoring equipment, anesthesia, and staffing allow it. Changing between side-lying, semi-reclined, kneeling, hands-and-knees, or supported upright positions can respond to comfort and descent rather than committing to one posture for the entire second stage.

When might the clinical team ask me to change position?

A position change may be needed for a fetal heart-rate concern, low blood pressure, better monitor contact, an examination, catheter care, assisted vaginal birth, shoulder dystocia response, or another urgent maneuver. The reason should be explained whenever circumstances allow.

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References

  1. Approaches to Limit Intervention During Labor and Birth

    ACOG · https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth

  5. Pushing/bearing down methods for the second stage of labour

    PubMed · https://pubmed.ncbi.nlm.nih.gov/28349526/

  6. Methods: BUMPES randomized trial

    NCBI Bookshelf · https://www.ncbi.nlm.nih.gov/books/NBK464232/

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.