Is the BEST pushing position flat on your back with your knees super wide?? No.
So, why is this the common pushing position in a hospital setting? It may be a misunderstanding of pelvic mechanics (it is a newer concept in general, even with many physical therapists). Or it may be that being on your flat with wider knees makes it easier to see for the provider.
Regardless of the WHY, spreading your knees WIDE and being flat on your back is usually NOT the most optimal way to create space for pushing.
Let’s explore what actually creates more SPACE in the bottom of the pelvis: internal rotation of the femurs.
Best Pushing Position: Internal Rotation
The BEST pushing positions is:
- The one YOU feel most comfortable in
But, if we want to take pelvic mechanics into consideration or you want to enhance your pushing position, we can focus on:
- internal rotation of the femurs (knees in, ankles out)
- slight posterior pelvic tilt (rounding in the low back)
- space for the sacrum to move (off your back)
Let’s break down each of these positions so you can better understand HOW to create space in the bottom of the pelvis + ways to prepare for pushing!
1. Knees In, Ankles Out
The pelvic outlet, or the bottom of the pelvis, opens more with internal rotation of the femurs, or KNEES IN, ANKLES OUT.
This will likely be the opposite of what you are coached to do in a hospital setting.
I cannot count the number of times I’ve heard the phrase:
“Spread your knees super wide to make space for the baby.”
I usually want to respond with: “where are we making space exactly?”
Internal rotation of the femurs spread the ischial tuberosities, or sitz bones, further apart. This creates more space side-to-side in the bottom of the pelvis.
If you don’t believe me, sit on your hands and move your legs around.
- Place your hands on your sitz bones
- Spread your knees wide and bring your ankles in (external rotation)
- You should feel your sitz bones move CLOSER together
- Bring your knees closer and ankles out (Internal rotation)
- You should feel your sitz bones move FURTHER apart
If we want to create more space in the bottom of the pelvis, we need to focus on internal rotation.
AND we can do this in a number of positions:
- all fours,
- side-lying,
- supine,
- standing…
You can find knees in, ankles out in ANY position!
2. Slight Posterior Pelvic Tilt
Next, a slight posterior pelvic tilt makes finding internal rotation EASIER.
We do NOT want to completely round in the back due to pressure management (neutral spine position = stronger pushes thanks to the diaphragm) and a big posterior pelvic tilt COULD decrease the space by moving the tailbone IN.
But we do want a SLIGHT posterior pelvic tilt to make internal rotation easier.
However, during pregnancy, we tend to favor a more extended position AND external rotation. So, we may want to focus on pelvic and spinal mobility to support finding movement again in the pelvis.
In our prenatal fitness programs and pelvic floor prep for birth course, we incorporate pelvic mobility so you can MOVE during your pregnancy and birth to create space in your pelvis!
Watch the video below for an idea of how to find a posterior pelvic tilt by releasing the quad and hip flexors!
3. Create Space for the Sacrum
Then, we want to create more space front to back in the pelvis! We can do this by making space for the sacrum.
The easiest way to create space for the sacrum is to GET OFF YOUR BACK.
But sometimes, pushing on your back may feel most comfortable (which would make it the best pushing position for you).
If you do want to push on your back, consider:
- Use a pillow to roll slightly to the side (my personal fav)
- Roll up a blanket to make a U shape and place your hips in the U
- Use the cut-out portion of the bed to place your hips into
If you feel more comfortable in upright pushing positions, or even side-lying, you will be creating space for your sacrum to move!
Make Pushing Easier with Pelvic Mechanics!
Spreading the knees super wide and being flat on your back tends to decrease the space in the bottom of the pelvis, which could make pushing longer and harder.
But, babies still come out with this method which is why it is still coached in a hospital setting (why change what appears to be working).
If you want to push easier and faster, try focusing on these mechanics:
- internal rotation with knees in, ankles out
- SLIGHT posterior pelvic tilt
- get off your back and make space for the sacrum
Thinking about pushing a baby out of your body can produce some anxiety! But it does NOT need to be mysterious and scary.
We break down the science of birth so you know HOW to approach pushing to feel confident as you navigate your birth experience.