Benefits of Upright and Spontaneous Pushing and How to Get Support For What You Want

/ The Happiest Doulas/

No matter which birth option you choose - medicated or unmedicated - the key takeaway is to have the right support around you to optimize your birth outcome. Throughout the course of labor, including the pushing stage, women benefit from frequent position changes and ideally, should be free to select them at will.

birthing positions


Lamaze’s Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Urges to Push

In order to avoid giving birth on your back, following the Healthy Birth Practices of allowing labor to begin on its own, changing positions throughout labor, having continuous support, and avoiding unnecessary interventions really come into play.

First and foremost, allowing labor to begin on its own is a key ingredient of avoiding unnecessary interventions that in turn could possibly cause you to have to give birth on your back because it avoids the use of synthetic drugs to get your labor started. Changing positions and having continuous support throughout your labor will also help you avoid interventions like medical pain management by easing the intensity of contractions.

Throughout history, women have been pictured giving birth in positions that are much more suitable for positive birth outcomes. Squatting, sitting, and standing all use the help of gravity to move the baby down and open the pelvis so the baby has more room to descend. Being able to freely change positions is much needed during labor, not only to ease discomfort, but to promote natural descent of the baby. Freedom of movement and working with your body will allow you to determine what position is optimal for you to push.

Many care providers prefer women to birth on their backs with their legs up in stirrups simply because it's easier access to seeing and catching the baby. Laboring on your back generally comes with directed pushing because it's likely that you've had an epidural which caused you to have to be on your back in the first place, otherwise you’d likely need/want to move during the pushing phase. (With an epidural, you may not feel the urge to push and need guidance on when and how to push effectively.)

Directed pushing is exhausting and according to the Lamaze website, “Goer and Romano (2012) found evidence to demonstrate that directed, forceful pushing had the potential to increase pressure on the baby and the umbilical cord, and the tissues of the perineum, resulting in more tears and a weaker pelvic floor musculature which can result in urinary incontinence."

To help ensure you have the ability to birth in the position you choose, follow these tips:

  1. Talk to your care provider and choose one who fully supports any position for labor and birth.

  2. Hire a doula or be sure to have continuous labor support available to help you avoid unnecessary pain medications. A doula is also very helpful with positioning if you do end up needing pain medication that limits mobility.

  3. Get educated by taking a birth preparation class. The more you know about birth and what's normal, the more confidence you will have in the birth process and the more comfort measures you will learn.

  4. Labor at home for as long as possible. The earlier you get to the hospital, the more likely you may be to use pain relief medication. Think of it like a kid in a candy store. If the "candy" is there, you may want to sample it!


When NOT lying on your back while giving birth, you oxygenate your body as you won't be lying on your aorta. Since the evidence is not strong enough at this point to recommend one specific birthing position over another, you should receive support to birth in whatever position feels right to you. However, flexible sacrum positions—those where you don’t put your weight on your tailbone—appear to be more helpful to normal vaginal birth.*

No matter what birth option you choose, medicated or unmedicated, the key takeaway is to have the support around you who will optimize your birth outcome. Throughout the course of labor, including the second (pushing) stage, women benefit from frequent position changes and ideally, should be free to select them at will.

This post is part 6 of a 7 part series written by our team of Lamaze Childbirth Educators. Stay tuned for our final post in this series, Keep Parent and Baby Together.

Part 1 can be read here.
Read part 2, Hormones and the Waiting Game
Read part 3, Make Labor Productive
Read part 4, When Childbirth Moved Into Hospitals
Read part 5, Avoid Routine Medical Interventions
Read part 7, Keep Parent and Baby Together

Resources cited:

https://www.lamaze.org/Connecting-the-Dots/book-review-optimal-care-in-childbirth-the-case-for-a-physiologic-approach-reviewed-through-a-childbirth-educators-eyes

https://www.lamaze.org/Portals/0/HBP%20%235%20Avoid%20Giving%20Birth%20on%20Your%20Back%20and%20Follow%20Your%20Body%27s%20Urges%20to%20Push.pdf

*Excerpt from Evidence Based Birth Handout, Evidence on Birthing Positions.
https://evidencebasedbirth.com/evidence-birthing-positions/