Best Positions for Birth: Understanding and Supporting Your Baby’s Journey

Birth, Birth Preparation, Labor Biomechanics

When preparing for labor, one common question is, “What is the best position for birth?” The answer is not straightforward, as there is no single “best” position that works for everyone. Labor and delivery are dynamic processes, and what works best can change as labor progresses and as the baby navigates through the pelvis. This blog post will discuss the various positions that can be beneficial during different stages of labor, the movements that can help your baby navigate the pelvis, and how you can prepare during pregnancy to support these processes.

No One-Size-Fits-All Position

The idea that there is one ideal labor position is a misconception. Both the laboring person and the baby will benefit from changing positions throughout labor. Each stage of labor and each level of the pelvis may require different positions to facilitate the baby’s movement and descent.

The Pelvic Inlet

The top of the pelvis, known as the pelvic inlet, is where the baby first engages. To open the pelvic inlet, movements that involve wide knees and external hip rotation, such as deep squats and butterfly poses, are effective. These positions create space side-to-side in the top of the pelvis, which can help the baby to engage.

Key Movements:

Deep Squats: Help in opening the top of the pelvis by moving the knees outward.
Butterfly Pose: Another position that promotes external hip rotation and opens the pelvic inlet.
Pelvic Tilting: Both anterior (arching the back) and posterior (tucking the butt) pelvic tilts can help create space. This tilting motion can be done on a birthing ball or all fours.

The Mid Pelvis

Once the baby has engaged in the pelvic inlet, they need to rotate to navigate the mid pelvis. The mid pelvis requires a mix of movements that involve both internal and external hip rotations and asymmetrical positions.

Key Movements:

Lunges and Side Lunges: These asymmetrical movements can help the baby rotate through the mid pelvis.
Hands and Knees Positions: These positions can aid in the rotation and descent by using gravity and movement.

The Pelvic Outlet

As the baby moves down to the pelvic outlet, different positions can help create the necessary space for the final descent and birth. The pelvic outlet opens best with movements that involve knees close together and a slight tuck of the butt.

Key Movements:

Knees Together, Ankles Out: This position can help open the outlet and facilitate the baby’s descent.
Leaning Forward Positions: Such as hands and knees or leaning over a birthing ball, can help the baby navigate the outlet.

Supporting Your Baby’s Journey

Understanding that there isn’t a single best position but rather a series of movements and positions that can help at different stages of labor is crucial. It’s also essential to listen to your body and move intuitively during labor. Changing positions every 20-30 minutes can help the baby find the optimal path through the pelvis.

Fetal Positions

Fetal position refers to how the baby is oriented within the uterus. The two main aspects of fetal position are:

Presentation: Which part of the baby is leading or coming out first (e.g., head, feet, or buttocks).
Position: The direction the baby’s body is facing relative to the mother’s pelvis (e.g., back-to-front or side-to-side).

Common Fetal Positions

Cephalic Presentation: The baby is head-down, which is the optimal position for birth. This can be further classified based on the baby’s head orientation:
- Occiput Anterior (OA): Baby’s head is down, and their back is facing the mother’s front. This is the most favorable position for a smooth delivery.
- Occiput Posterior (OP): Baby’s head is down, but their back is facing the mother’s back. This position can cause a longer, more painful labor due to the baby’s harder path through the pelvis.
- Occiput Transverse (OT): Baby’s head is down, but they are facing the mother’s side. This position can also lead to a more challenging labor.
Breech Presentation: The baby’s buttocks or feet are positioned to come out first. Breech positions are less common and may require special attention, sometimes leading to a cesarean delivery.
Transverse Lie: The baby is lying sideways across the uterus. This position is uncommon and usually requires a cesarean delivery if the baby does not turn before labor begins.

Cardinal Movements of Labor

The cardinal movements are the series of movements the baby’s head and body make to navigate through the birth canal. These movements are critical for a successful vaginal delivery.

Engagement: The baby’s head enters the pelvic inlet. In a well-aligned cephalic presentation, the baby’s head is engaged in the pelvis.
Descent: The baby moves downward through the pelvis. This movement happens throughout labor, especially during contractions.
Flexion: As the baby descends, their head flexes so that the chin tucks into the chest, presenting the smallest diameter of the head to the birth canal.
Internal Rotation: The baby’s head rotates to align with the mother’s pelvis. Typically, the baby’s head rotates from an occiput transverse (side-facing) position to an occiput anterior (facing the mother’s back) position.
Extension: As the baby reaches the pelvic outlet, the head extends to pass under the pubic bone. This movement allows the head to emerge from the birth canal.
External Rotation (Restitution): After the head is born, it rotates to align with the shoulders, which are still inside the pelvis. This external rotation helps the shoulders navigate through the birth canal.
Expulsion: The baby’s shoulders and the rest of the body are delivered, completing the birth process.

Mamastefit: the number one thing I recommend to all my pregnant friends. I did the prenatal fitness program via team builder app and the childbirth education classes. Both were highly valuable, but the fitness program is what my husband and I attribute to my really fast and smooth postpartum recovery. The fitness program allowed me to feel limber and strong in my pregnant body. The program allows you to go at your own pace, your own chosen weights, and the ability to shorten/lengthen the workout day depending on how your body is feeling that day. The exercises were also great ones that I would not have thought of to do on my own. The childbirth education classes had a lot of great information and I was able to implement many of the labor movements and breathing exercises during labor. 10/10 would recommend and will absolutely be using their program again and again!

I just wanted to say thank you so much for all of your incredible content! I used your childbirth edu and prenatal fitness programs during my pregnancy and felt empowered to take on an unplanned induction. As a pelvic PT, I knew I wanted education that covered physiology and hospital birth interventions in a lot more specific detail and I felt the mamastefit program was comprehensive and easy to digest with the format you have. I will definitely use the prenatal fitness plan again for a future pregnancy and will totally recommend it to patients as well!

I had my final postnatal appointment and my midwife says she has never seen such a healthy postpartum pelvic floor, in fact if she didn't know better she would have guessed that I hadn't had any children. The whole team was amazed at my overall physical recovery which I attribute to your programming and the nutritional guidelines from Lily Nichols. They are recommending your program to more of their clients because of my great results. Thank you!

Preparing During Pregnancy

During pregnancy, we do not need to force baby into one specific position–they will likely shift positions throughout the day so this could be wasted effort and simply increase anxiety.

Rather, we can ensure that baby’s path to rotate is clear! We can do this with exercises to release common areas of tension to make it easier for baby to rotate to their best position when labor does begin.

Some common areas of tension could include:

Uterine ligament tension--ensuring that the ligaments that attach the uterus to the pelvis are well balanced. This could include incorporating exercises like a forward leaning inversion to release tension in the uterosacral ligaments and round ligaments, or belly sifting to release tension in the broad ligament.
Pelvic mobility--this ensures that you have good movement and mobility of the pelvis to be able to create more space in the bony structure in all three pelvic levels. Commonly, the lower pelvis is harder to create space.
- In order to address common areas of prenatal tension, we want to focus on releasing tension in the lats and hip flexors–which we address in the MamasteFit Birth Prep Circuit.
Pelvic floor tension–the pelvic floor attaches to the pelvis, therefore we need a variety of hip movements to release tension in the pelvic floor. This includes both wide legged positions, such as deep squats, and also internally rotated positions such as hero’s pose with asymmetrical movements.

Watch this workout video for some exercises you can do during pregnancy to support your baby’s position for birth!

If you want more daily workouts to support a strong pregnancy as you prepare for birth, join our online prenatal fitness programs!

MamasteFit is unique in that we are one of the ONLY prenatal/postnatal training facilities in the United States. We develop our workout programs from our experience of working with in-person pre/postnatal fitness clients and work closely with physical therapists to refine our programming. In addition, we are birth workers, so we combine our experience as perinatal fitness trainers and birth professionals to ensure that our programs actually support your birth preparation and recovery!

Our prenatal fitness programs are offered in several formats:

40-Week Prenatal Strength Program in the Teambuildr App:
- This program is a self-paced workout with shorter demo videos. This is ideal if you like to workout in a gym setting and prefer a traditional workout delivery format.
- This program syncs to your current week of pregnancy, so you can start anytime, with one-time payment or month-to-month payment options.
- This program has a full and mini version, depending on how much time you have to dedicate to workouts!
Prenatal On-Demand Fitness Program:
- If you prefer to follow a video as you workout at the same time, this workout program will be the best option!
- This program syncs to your current trimester, so you can grab the trimesters you need!
Birth Prep Workout Program:
- If you already have a workout routine or you only want birth prep-focused workouts, check out this program!
- This program includes full-length workout videos to follow as you workout at the same time.
Prenatal Yoga Classes:
- If you want prenatal yoga, join our prenatal yoga program! This also syncs to your current trimester.

Conclusion

Labor is a dynamic process that requires flexibility and a variety of movements. There is no single best position for labor and birth, but rather a range of positions that can help at different stages. Preparing your body during pregnancy with exercises that promote flexibility and strength can make it easier to move through these positions intuitively during labor. Remember, the best position is the one that feels right for you and supports your baby’s journey through the pelvis.