What is the best position for a mother to deliver a baby?

Best Position for Childbirth: Evidence-Based Recommendations

Since no childbirth position is demonstrably superior to another, the best position for delivery should be selected in coordination with the mother, choosing the position in which both the mother and caregiver will be most at ease to achieve delivery. 1

Evidence on Birthing Positions

Guidelines and Expert Recommendations

The 2022 guidelines for the management of urgent obstetric situations provide clear direction on this topic:

• No childbirth position has been proven superior to others for maternal and fetal outcomes 1
• Position selection should be a collaborative decision between the mother and healthcare provider 1
• Outside specialized settings, maintaining the option to quickly place the patient in a supine position compatible with the McRoberts maneuver is recommended (legs hyperflexed tightly to abdomen) 1

Benefits of Different Positions

Upright Positions (standing, sitting, squatting, kneeling)

• Reduce first stage labor duration by approximately 1 hour and 22 minutes 2
• Associated with lower cesarean section rates (29% reduction) 2
• Reduce need for epidural analgesia 2
• Allow greater coccyx movement (15.7° rotation) and less pubic symphysis widening (3 mm) 3
• May utilize gravity to assist with fetal descent

Hands-and-Knees Position

• Significantly reduces persistent back pain during labor 4
• May help with fetal rotation from occipitoposterior to occipitoanterior position 4
• Shows trends toward improved birth outcomes including reduced operative delivery 4

Left Lateral Position

• Attenuates hemodynamic impact of uterine contractions 1, 5
• Improves maternal hemodynamics including blood pressure and cardiac output 5
• Enhances fetal parameters of oxygenation and heart rate 5
• Ensures adequate venous return from the inferior vena cava 1

Special Considerations

Cardiac Conditions

• For women with cardiac conditions, a sitting-up position may be needed for those in cardiac failure 1
• Left lateral position is recommended to ensure adequate venous return 1

Shoulder Dystocia

• In cases of shoulder dystocia, the McRoberts maneuver (supine with legs hyperflexed) is recommended as first-line intervention 1

Impacted Fetal Head

• For impacted fetal head during cesarean delivery, specialized techniques like reverse breech extraction may be necessary 1

Practical Implementation

1. First Stage of Labor:

   • Encourage mobility and upright positions to reduce labor duration 2
   • Walking and upright positions reduce risk of cesarean birth and need for epidural 2

2. Second Stage of Labor:

   • Allow the woman to choose her preferred position in coordination with the healthcare provider 1
   • Consider hands-and-knees position for women with persistent back pain or occipitoposterior fetal position 4
   • Maintain the option to quickly transition to supine position if needed for interventions 1

3. Special Circumstances:

   • For women with cardiac conditions, consider left lateral or sitting-up positions 1
   • Be prepared to implement the McRoberts maneuver if shoulder dystocia occurs 1

Common Pitfalls to Avoid

• Imposing supine position without medical indication: Many women use the supine position simply because they are instructed to do so by healthcare providers 6
• Failing to inform women about position options: Women should be informed about the benefits of upright positions 2
• Not considering the woman's comfort: The woman's comfort and preference should be prioritized when medically appropriate 1
• Restricting mobility: Unnecessary restriction of mobility may prolong labor and increase intervention rates 2

The evidence clearly supports allowing women to choose their preferred birthing position while maintaining readiness to adjust as needed for medical interventions. This approach optimizes both maternal satisfaction and clinical outcomes.