Upright birth positions are any positions where gravity is on your side: standing, walking, swaying, sitting forward, kneeling, squatting, and hands and knees. You do not need to pick one in advance. Most people move through several, and the best ones are the ones your body keeps asking for. Below, you’ll find each position, what the research says, how to use counter pressure, and the questions worth bringing to your provider.
TL;DR
- Upright positions include walking, swaying, leaning forward, lunging, kneeling, squatting, and hands and knees, with a partner, ball, chair, or pillows for support.
- ACOG cites a meta-analysis finding upright positions shorten the first stage of labor by about 1 hour and 22 minutes compared with lying down.
- In pushing, upright or side-lying positions are linked to fewer episiotomies and fewer operative vaginal births than lying on your back.
- Counter pressure is firm, steady pressure on your hips or lower back during a contraction. Your feedback guides your partner’s hands.
- Pain relief, monitoring, or complications can change what’s available, so ask your provider which positions work for your plan.
Table of Contents
- The upright positions worth knowing
- What the evidence says
- Counter pressure: how to do it
- When your options change
- Our perspective
- Practice before labor with us
- FAQ
- Sources
The upright positions worth knowing
The Mayo Clinic’s labor positions guide lists standing, walking, swaying, rocking while seated, leaning forward, lunging, kneeling, squatting, and hands and knees. It also names the supports that make them easier: a partner, a sturdy chair or table, a birthing ball, pillows, or the bed itself.
Here is how I describe them to clients in Newtown and Doylestown:
| Position | How it feels | Helpful when |
|---|---|---|
| Walking or slow swaying | Rhythmic, distracting, easy to pause | Early labor, or when you need a change of scenery |
| Leaning forward on a partner, counter, or bed | Takes weight off your back | Contractions are strong and you’re tired |
| Sitting on a birth ball | Gentle rocking and circles | You want to rest without lying flat |
| Lunging (one foot up on a chair) | Opens one side of the pelvis at a time | Labor feels stuck or baby needs help rotating |
| Kneeling, leaning over the ball or bed | Easy on knees with pillows, relieves back pressure | Back pain or long stretches of laboring |
| Hands and knees | Frees the lower back and lets you rock | Strong back sensations, or resting between pushes |
| Squatting (supported) | Uses gravity, opens the lower pelvis | Pushing, often with a bar, partner, or squat support |
No position is a test you can fail. Switching every 20 to 30 minutes, or whenever something feels off, is usually enough.
What the evidence says
The ACOG Committee Opinion on limiting intervention cites a meta-analysis in which walking, sitting, standing, and kneeling shortened the first stage by roughly 1 hour and 22 minutes compared with recumbent positions.
For pushing, ACOG cites a Cochrane meta-analysis. Upright or lateral positions, compared with lying on your back, were associated with fewer episiotomies, fewer operative vaginal births, and fewer abnormal fetal heart rate patterns.
The same ACOG document also says that for most women no single position needs to be required or forbidden, and that people naturally use many positions in labor. So the takeaway is not “upright or nothing.” It’s that moving freely gives you more options and tends to help.
Pro tip: Ask your provider, “Which positions do you support for pushing, and how do you monitor baby when I’m not in bed?” Their answer tells you a lot about how mobile you can expect to be.
Counter pressure: how to do it
Counter pressure is firm, steady pressure from a partner’s hands or a doula’s against your body while a contraction peaks. Many people find it eases the deep ache in the low back and hips. These are the three versions we practice in class:
- Sacral pressure. Find the flat, triangular bone at the base of your spine. Your partner places the heel of one hand there and presses firmly, leaning in with their body weight rather than their arm muscles. This is the one most people reach for with back labor.
- Double hip squeeze. With you standing, leaning forward, or on hands and knees, your partner places a palm on each side of your buttocks, just behind the hip bones, and presses in and slightly up toward the center.
- Hip press. Palms rest on the tops of the hip bones, pressing straight inward.
How your partner knows whether to adjust
You are the guide. A few things I coach partners on:
- Start with the contraction. Press as it builds, hold through the peak, and ease off as it fades.
- Ask, don’t guess. “Higher, lower, harder, softer?” Short words work best in labor.
- Watch for tension. If your shoulders rise or you pull away, the pressure is too much or in the wrong spot. Relief usually shows as a long exhale and a softer face.
- Stay steady. Constant pressure often feels better than rubbing or changing mid-contraction.
- Pace your partner. Sacral pressure is tiring. Switching hands, or taking a turn with your doula, keeps it strong.
Try it a few times before labor so you both know what feels good. Our step-by-step guide to supporting your partner in labor and the partner’s role in childbirth walk through more hands-on comfort work, and our comfort measures overview shows how counter pressure fits alongside other tools.
When your options change
Plans shift, and that’s okay. Mayo Clinic notes that certain pain relief medicines may require you to stay in bed or in a specific position. ACOG supports frequent position changes for comfort and fetal positioning, as long as they allow proper maternal and fetal monitoring and aren’t ruled out by complications.
What that means for you is a conversation to have with your provider, ideally at a prenatal visit at your hospital, whether that’s Trinity Health St. Mary or another Bucks County or Princeton-area facility. Questions to ask:
- Is wireless or intermittent monitoring available so I can move?
- If I have an epidural, how often can I be repositioned, and which positions do you use?
- What would make you ask me to stay in bed?
If you’re planning an epidural, you still have choices. Our practical guide to birth positions with an epidural covers side-lying and supported positions, and the post on labor and delivery beds explains how to use the bed itself for upright support.
And once baby arrives, your body keeps working. The uterus contracts as it shrinks back, and if you want to plan ahead, this guide to postpartum cramp relief covers drug-free options to discuss with your provider.
Our perspective
Upright positions are less about a perfect pose and more about feeling like an active participant in your own birth. After more than ten years as a doula in Bucks County, I’ve seen how much calmer a laboring parent becomes when she knows she can move, and when her partner knows exactly where to put their hands.
That’s why we pair birth support with hands-on preparation. In our childbirth education, we rehearse positions, counter pressure, and the questions to ask your provider, so nothing in the room feels unfamiliar. During labor, I watch for the small signs that it’s time to change position, offer a new idea, and hold the space so your partner can stay present rather than anxious.
We tailor all of this to your plan, whether you’re hoping for an unmedicated birth, an epidural, or a cesarean. Supported, informed, and unhurried: that’s what white-glove care means to us.
Alexis Wallace
Practice before labor with us
Positions feel natural when you’ve tried them before the big day. In our private childbirth education classes, you and your partner practice upright positions, counter pressure, and communication, shaped around your birth preferences. When labor begins, our pregnancy and birth doula support brings that preparation into the room with you.
To understand how doula care sits alongside your medical team, read what a doula does.
FAQ
What is the best position for labor?
There isn’t one. ACOG says that for most women no single position needs to be required or forbidden, and that people naturally try many. Upright positions have good evidence behind them, so start there, then change whenever you feel stuck or uncomfortable.
Can I use upright positions with an epidural?
Often you can use supported positions, though some pain relief medicines may keep you in bed or in a specific position, according to Mayo Clinic. Ask your provider which positions they use with epidurals, and how often you can be repositioned.
When should my partner start counter pressure?
Whenever the ache in your back or hips makes you want it. It’s applied during contractions, so your partner starts as one builds and eases off as it fades. Tell them what to adjust, and practice together during pregnancy.
Do I need a birth ball?
Not necessarily. Mayo Clinic lists a sturdy chair, table, pillows, the bed, or a partner as supports too. A ball is a comfortable option for sitting and rocking, and many hospitals have them. Ask your birth facility what’s provided.
If you’d like a calm, personalized plan for your birth, we’d love to meet you. Book a free consultation and we’ll talk through your hopes, your questions, and how we can support you and your partner.