Written by

Gina Conley, MS

November 5, 2026

Side-Lying Knee Lift for Labor Stalls: Creating More Space in the Pelvis to Help Baby Rotate

Birth, Birth Preparation, Labor Biomechanics, Labor Stalls, Pushing

Labor does not always progress in a predictable or linear way. Sometimes, especially during the later stages of labor, contractions may continue, but cervical dilation or baby’s descent appears to slow down or stop. This can happen when baby is having difficulty completing the rotations needed to navigate through the pelvis.

One position that can help create additional space in the pelvis during a late labor stall is the side-lying knee lift. This position uses a combination of hip rotation, pelvic rotation, and gentle compression to create more room in the lower mid-pelvis. It can be particularly helpful when baby is already low in the pelvis but is having difficulty completing the final rotation underneath the pubic bone.

In this article, we’ll explore how the side-lying knee lift works, why it may be beneficial during labor, how to get into the position, and how it differs from other side-lying labor positions.

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Understanding Baby's Rotation During Labor

For a baby to move through the pelvis during labor, they must navigate several different levels of the pelvis. This process involves more than simply moving downward. Baby also needs to rotate and adjust their position to fit through the available space.

As baby enters the pelvis, they begin navigating the upper portion of the pelvic cavity. From there, they continue to rotate internally as they descend. Eventually, baby needs to complete this rotation to move underneath the pubic bone and through the lower portion of the pelvis.

This rotation is an important part of labor progression.

Sometimes, however, baby may reach a lower position in the pelvis but have difficulty completing the final rotation underneath the pubic bone. When this happens, labor may appear to stall, even when contractions are continuing.

A late labor stall may occur around seven or eight centimeters of dilation, although labor progression varies from person to person. In these situations, the goal is to consider how the baby’s position and the available space within the pelvis may be influencing progress.

Rather than focusing only on contraction strength or cervical dilation, pelvic mechanics can help us think about how to create additional room for baby to continue moving and rotating.

Why the Lower Mid-Pelvis Matters

The pelvis is not one uniform opening. It has different levels, and the shape and available space change as baby moves through it.

The lower mid-pelvis is particularly important when baby is trying to complete the final stages of rotation underneath the pubic bone.

If baby is already relatively low but having difficulty navigating underneath the pubic bone, creating more space in this area may help support their continued movement.

The side-lying knee lift is designed to address this specific area of the pelvis.

By positioning the hips and pelvis in different rotational directions, we can create a combination of movement that helps lift the lower pubic bone on one side. This creates additional space underneath the pubic arch for baby to finish rotating.

The position uses two primary movements:

Internal rotation of the bottom hip and pelvis: This helps lift the bottom half of the pubic bone and create additional space in the lower mid-pelvis.
External rotation of the top hip: This allows the upper leg to relax into an externally rotated position while helping create length through the top side of the body.

Together, these movements create a position that can encourage additional space in the lower portion of the pelvis.

What Is the Side-Lying Knee Lift?

The side-lying knee lift is a labor position designed to create more room in the lower mid-pelvis when baby is having difficulty completing their rotation underneath the pubic bone.

Unlike positions that rely primarily on stretching or opening the legs, this movement uses a combination of internal rotation and compression.

The laboring person lies on their side with the bottom hip positioned in internal rotation. The bottom knee is supported by a pillow, bolster, or another support. The top leg rests on a peanut ball or similar support in a more externally rotated position.

During a contraction, the bottom knee is gently lifted while the bottom hip is pushed forward. This creates a compressive movement through the bottom hip and pelvis, helping lift that side of the pubic bone and create more space underneath the pubic arch.

The position can also incorporate gentle traction through the top leg and lengthening through the upper side of the body.

This combination makes the side-lying knee lift a useful option to consider when labor appears to be stalling because baby is having difficulty completing the final stages of rotation.

How to Set Up the Side-Lying Knee Lift

Step 1: Lie on the side baby is rotating toward

Begin by lying on the side that corresponds with the direction baby is rotating.

For example, if baby is rotating toward the right side of the laboring person’s body, they would lie on their right side.

If you are unsure which direction baby is rotating, beginning with the left side down may be a helpful starting point, as babies commonly rotate toward the left side.

A birth professional familiar with pelvic mechanics can help determine which side and position may be appropriate based on baby’s position and the circumstances of labor.

Step 2: Position the bottom hip in internal rotation

The bottom leg is the most important part of this position.

Place a pillow or bolster underneath the bottom knee. The goal is to bring the knee upward and slightly toward the body’s midline.

This creates internal rotation through the bottom hip.

The pelvis also rotates toward the femur, creating internal rotation through both the bottom hip and the bottom half of the pelvis.

If you do not have a pillow or bolster available, you can use a rolled-up towel or sheet. In some situations, the laboring person or their support person can use a hand to help maintain the desired position.

The goal is to keep the bottom knee supported in a lifted position rather than allowing it to fall backward or outward.

Step 3: Position the top leg in external rotation

The top leg should rest in a more externally rotated position.

A peanut ball works well for this because it provides support while allowing the leg to relax. Position the top leg over the peanut ball, allowing the ankle to hang comfortably and remain relaxed.

This positioning creates a difference in rotation between the two hips:

The bottom hip is internally rotated.
The top hip is externally rotated.

This combination helps create the desired pelvic positioning.

Step 4: Add the knee lift and hip compression

Once the laboring person is comfortably positioned, the next step is to incorporate the actual knee lift.

During a contraction, the support person can help by gently pushing the bottom hip forward while reaching underneath the bottom knee and lifting it upward.

Think about combining two movements:

Push the bottom hip forward.
Lift the bottom knee upward at the same time.

These movements work together to create compression through the bottom hip.

The combination of hip and pelvic positioning helps lift the lower half of the pubic bone, creating more space underneath the pubic arch.

The support person may need to experiment with hand placement to find the best leverage and maintain a comfortable position. Depending on the laboring person’s body position, one hand may work better than the other.

This movement can also be performed with assistance from another birth support person.

Step 5: Add additional length through the top side of the body

If additional support is available, there are a few ways to enhance the position.

One option is to have another support person hold the top ankle and gently pull to create more space through the top leg and side body.

Another person can assist by holding the top arm, creating additional length through the upper side of the body while the bottom hip is being pushed forward and the bottom knee is lifted.

This creates a coordinated movement involving the bottom hip, top leg, and upper body.

Although this version may require multiple support people, it can provide a nice combination of compression and lengthening.

You can also place a pillow or bolster underneath the bottom side of the torso. This helps create additional length through the top side of the body without requiring another person to hold the arm.

The goal is to maintain the bottom hip compression while allowing the upper side of the body to lengthen.

The Pelvic Mechanics Behind the Side-Lying Knee Lift

What makes this position unique is how it uses the rotation of the hips and pelvis to influence the available space in the lower mid-pelvis.

When the bottom knee is lifted toward the midline, the bottom hip moves into internal rotation. At the same time, the pelvis rotates toward the femur.

This combination creates internal rotation through the bottom side of the pelvis.

As the bottom hip is lifted and compressed forward, the corresponding half of the pubic bone lifts upward. This changes the available space underneath the pubic arch.

The goal is to create additional room on the bottom side of the lower mid-pelvis so baby has more space to complete their rotation.

Meanwhile, the top leg remains in external rotation, and the upper side of the body can be lengthened through gentle traction or additional support.

Rather than simply pulling the legs apart, the position uses opposing rotational movements to influence the shape and available space within the pelvis.

This is an important distinction because not every labor position needs to focus on creating a wider opening through the legs. Sometimes, changing the rotation and relationship between the hips and pelvis can be more useful for the specific movement baby needs to make.

Who May Benefit From the Side-Lying Knee Lift?

The side-lying knee lift can be particularly beneficial when baby is already low in the pelvis but is having difficulty completing the final rotation underneath the pubic bone.

It is designed to address a specific type of late labor stall rather than being a position that needs to be used throughout every labor.

There are also a few situations in which this position may be especially useful.

1. When Baby Is Low but Having Difficulty Finishing Rotation

One of the primary reasons to consider this position is when baby has descended into the pelvis but is struggling to complete the final rotation underneath the pubic bone.

In this situation, creating more space in the lower mid-pelvis may help support baby’s continued movement.

The side-lying knee lift specifically targets this area by lifting the bottom half of the pubic bone and creating more room underneath the pubic arch.

2. For Individuals With Hypermobility

The side-lying knee lift may also be a helpful option for individuals who are hypermobile.

Hypermobility can influence how someone experiences certain labor positions. Positions that rely on large ranges of motion or passive stretching may not always provide the desired sensation of release.

The side-lying knee lift uses compression rather than relying exclusively on a large stretch.

This can make it feel more supportive and effective for individuals who are hypermobile and may not experience much of a release with traditional side-lying positions.

3. For Individuals Experiencing Pelvic Pain

Some labor positions can be uncomfortable for individuals who already experience pelvic pain.

The traditional side-lying release, for example, involves allowing the top leg to hang off the side of a bed or table. While this can create space in the pelvis, the position can also be painful for individuals with pelvic discomfort.

The side-lying knee lift offers another option.

Instead of relying on the top leg hanging off the bed, this position uses internal rotation and compression through the bottom hip to create space.

Many individuals with pelvic pain find the compression movement more comfortable and report feeling the opening through the pelvis.

The goal is to find a position that supports pelvic mechanics without creating unnecessary discomfort.

Side-Lying Knee Lift vs. Traditional Side-Lying Release

The side-lying knee lift is similar to the traditional side-lying release, but there are some important differences in how the positions are performed.

A traditional side-lying release generally involves allowing the top leg to hang off the side of the bed or table. This creates a position intended to encourage release and movement through the pelvis.

However, this position can sometimes be uncomfortable, particularly for individuals with pelvic pain or hypermobility.

The side-lying knee lift uses a different approach.

Traditional Side-Lying Release	Side-Lying Knee Lift
Top leg hangs off the bed or table.	Both legs remain supported.
Uses positioning to encourage a release through the pelvis.	Uses internal rotation and compression through the bottom hip.
Can be uncomfortable for individuals with pelvic pain.	May feel more comfortable because it does not require the top leg to hang off the bed.
May not provide a noticeable release for some hypermobile individuals.	Uses a compression-based movement that many hypermobile individuals find beneficial.

One of the biggest advantages of the side-lying knee lift is that it offers another way to create space in the lower pelvis without requiring the laboring person to tolerate a position that may aggravate existing pelvic discomfort.

For individuals who do not feel much of a release with the traditional side-lying release, the compressive nature of the knee lift may provide a different and more comfortable experience.

Working With Your Birth Support Team

Labor positions can sometimes be difficult to achieve independently, especially when a specific combination of movements is involved.

Having a knowledgeable birth support team can make it easier to get into a position and maintain it during contractions.

For the side-lying knee lift, one support person can help stabilize the bottom leg and provide the forward pressure through the hip.

If additional support is available, another person can assist with the top ankle or arm to create more length through the upper side of the body.

However, this position does not necessarily require multiple people. The basic movement can be performed with one support person, and adjustments can be made depending on the laboring person’s comfort and available support.

A birth doula, midwife, or other trained birth professional can help determine whether this position is appropriate based on baby’s position, labor progression, and the individual’s needs.

It is also important to remember that labor positions are tools, not guarantees. A position may help create more space, but it does not guarantee that labor will progress or that baby will rotate. If labor appears to have stalled, the birth team should assess the overall clinical picture and determine the appropriate next steps.

Using Pelvic Mechanics to Support Labor Progression

The side-lying knee lift is one example of how understanding pelvic mechanics can help us think more intentionally about labor positions.

Rather than choosing positions simply because they are commonly recommended, we can consider what movement baby needs to make and what part of the pelvis may benefit from additional space.

For example:

If baby is trying to engage in the pelvis, we may consider positions that support space in the upper pelvis.
If baby is internally rotating, we may consider positions that encourage the appropriate rotational movements.
If baby is low but having difficulty completing the final rotation underneath the pubic bone, we may consider positions that create more space in the lower mid-pelvis.
As baby gets ready to push, we can continue using pelvic mechanics to explore positions that support baby’s movement through the pelvis.

The side-lying knee lift is particularly useful for that late labor situation when baby is low but having difficulty finishing the rotation underneath the pubic bone.

Understanding these different movements gives birth professionals and laboring individuals more options to explore when labor does not seem to be progressing as expected.

Final Thoughts: Creating More Space for Baby During a Late Labor Stall

When labor appears to stall during the later stages, it can be helpful to look beyond contractions and cervical dilation and consider how baby’s position may be influencing progression.

The side-lying knee lift is a labor position designed to create more space in the lower mid-pelvis by combining internal rotation of the bottom hip and pelvis with external rotation of the top hip.

Through a gentle lifting and compressive movement, the position helps elevate the bottom half of the pubic bone, creating additional room underneath the pubic arch for baby to complete their final rotation.

It can be a particularly useful option for individuals with hypermobility or pelvic pain who may find traditional side-lying releases uncomfortable or less effective.

Every labor is different, and the most helpful position depends on where baby is in the pelvis and what movement they need to make next. Having a variety of pelvic mechanics tools available can help birth teams make more intentional positioning choices throughout labor.

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