Benefits of upright pushing in labor

Evidence shows that women should be allowed to make choices about the birth positions in which they might want to assume for the birth of their baby. Frequent position changes in the second stage may reduce the length of the second stage. (Golara. 2002) Researchers hypothesize that pushing in an upright position is beneficial for multiple reasons. In an upright position, gravity can assist in engaging the baby down and out. Also, when a woman is upright there is less risk of compressing the mother’s aorta and therefore a better oxygen supply to the baby. Upright positioning also helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis. Finally, X-ray evidence has shown that the pelvic outlet becomes wider in the squatting and kneeling positions. (Gupta. 2012)

Upright positions are defined as sitting (on a birthing stool or cushion), kneeling, and squatting. Non-upright positions are defined as side-lying, semi-sitting, and supine (back-lying with feet up in stirrups or supported by care givers hands). Research confirms that giving birth in a supine position has distinct disadvantages without demonstrable benefits to either mother or infant. Squatting can be the most exhausting position and is frequently combined with side-lying, semi-sitting and kneeling with resting between contractions. Even though positions such as side-lying, kneeling, and semi-reclining lose the advantages associated with gravity, other benefits include heightened relaxation and the opportunity to rest more effectively between contractions. Throughout the course of labor women benefit from frequent position chances and ideally, should be free to select or reject them at will.

The use of epidural frequently limits the ability of the laboring woman to change position without assistance. Even distribution of the pain medication is best achieved when the woman remains supine or semi-reclined. (Roberts & Hanson. 2007) Maternal movement is also complication by the need for iv fluids, continuous monitoring, and the use of urinary catheters. These common practices do not prevent women from using a variety of positions during labor and birth but may not be achievable without a great deal of assistance. Almost three-quarters of women in the U.S. (71%) receive an epidural during childbirth (Declercq. 2007). There have been only two randomized, controlled trials that compared upright versus non-upright pushing positions in women with epidurals.  Results from both studies show that being upright during the second stage of labor shortens labor in women with epidurals.

Families should understand the benefits of approaching birth with an evidence-based approach that allows for self-determined positions throughout the second stage of labor. Understanding that the length of second stage is variable and may be prolonged without adverse effects. Continuous labor support aids in this approach by helping the birthing person and partner feel knowledgeable and supported about their birthing decisions and recognizing that they have choices in their birth. Women should be allowed to give birth in whatever position they are comfortable in.