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Could Upright Positions During Labor Support Better Birth Outcomes?
For generations, women have instinctively moved, squatted, knelt, leaned forward, or used hands-and-knees positions during labor. Yet in many modern birth settings, giving birth while lying on the back or in a semi-reclined position remains common.
A 2026 study published in Women and Birth offers new evidence that the position a woman adopts during the active second stage of labor—the pushing and birth stage—may be associated with how the baby is born.
The researchers found that spending more time in upright positions was associated with a greater likelihood of physiological birth, while spending more time lying on the back was associated with a higher likelihood of instrumental birth.
What did the study examine?
The prospective observational study followed 330 first-time mothers who were at term and planning a vaginal birth.
During the second stage of labor, midwives recorded:
- When the active second stage began
- The positions each woman adopted
- Every change in position
- How much time was spent upright or lying back
- Whether the birth was physiological or required instrumental assistance
Upright positions included options such as being on all fours or using a birth stool. Supine positions involved lying on the back, while semi-recumbent and lithotomy positions involved reclining or lying back with the legs supported.
Because this was an observational study, the researchers watched what happened during labor rather than assigning women to specific positions.
What were the outcomes?
Of the 330 women included in the study:
- 216 women, or 65%, had a physiological birth.
- 114 women, or 35%, had an instrumental birth.
Women who had physiological births were more likely to have used an all-fours position or a birth stool. Those who experienced instrumental births were more frequently in semi-recumbent or lithotomy positions.
The most striking findings involved the amount of time spent in each type of position:
- For every 10% increase in time spent upright during the active second stage, the likelihood of physiological birth increased by 26%.
- For every 10% increase in time spent in a supine position, the likelihood of instrumental birth increased by 30%.
These figures show an association—not proof that position alone caused the birth outcome. Labor is complex, and factors such as epidural use, fetal position, clinical complications, maternal fatigue, and the need for medical intervention may influence both the position used and the eventual mode of birth.
Still, the results suggest that helping women remain mobile and use upright positions, when medically appropriate, may support the body’s physiological birth process.
Why might upright positions help?
Upright and forward-leaning positions may offer several practical and physiological advantages during labor.
Working with gravity
Standing, kneeling, squatting, sitting on a birth stool, or leaning forward may allow gravity to assist the baby’s descent through the pelvis.
Creating space in the pelvis
Certain upright positions may encourage movement of the pelvis and sacrum. Positions such as hands-and-knees, kneeling, and supported squatting can allow the laboring person to adjust their posture in response to pressure and the baby’s movement.
Supporting instinctive movement
Many women naturally want to move or change positions during labor. Freedom of movement can help them respond to contractions, manage discomfort, and find positions that feel more effective.
Encouraging active participation
Being able to choose and change positions may also help the laboring person feel more involved in the birth process rather than feeling that birth is simply happening to them.
Does this mean everyone should give birth upright?
Not necessarily.
There is no single position that is right for every woman or every birth. Some people may feel strongest and most comfortable standing or kneeling, while others may prefer side-lying, supported sitting, or another position.
Clinical circumstances may also make certain positions difficult or inappropriate. Epidural anesthesia, continuous monitoring, maternal exhaustion, fetal concerns, or the need for an assisted birth may affect which positions can be used safely.
It is also important to interpret the direction of the association carefully. Some women may have been moved into semi-recumbent or lithotomy positions because an instrumental birth had already become necessary. Therefore, the position may sometimes be a result of the developing clinical situation rather than its cause.
The practical message is not that women must remain upright. It is that, when circumstances allow, they should be informed of their options and actively supported to move and choose positions that work for them.
How can doulas support freedom of movement?
Doulas can play an important nonmedical role in helping families explore different labor positions.
Depending on the laboring person’s preferences and the guidance of the clinical team, a doula may:
- Suggest position changes for comfort and rest
- Help the client use a birth ball or peanut ball
- Support hands-and-knees, kneeling, lunging, or side-lying positions
- Use pillows, chairs, rebozos, or a partner for physical support
- Encourage the client to communicate her positioning preferences
- Remind the family about options discussed in the birth plan
- Help adapt positions when movement is limited
- Work collaboratively with nurses, midwives, and physicians
Doulas do not decide which position is medically appropriate or guarantee a particular birth outcome. Their role is to offer continuous support, help clients understand and communicate their preferences, and encourage informed collaboration with the clinical care team.
What can expecting parents do?
Before labor, expecting parents can ask their provider or birth facility questions such as:
- Will I be encouraged to move during labor?
- What positions can I use during the pushing stage?
- Are birth stools, birth bars, peanut balls, or wireless monitors available?
- What positions may be possible if I receive an epidural?
- Under what circumstances might I need to give birth in a reclined or lithotomy position?
- Can my doula and partner help me change positions?
Practicing several positions during pregnancy or childbirth education can also make them feel more familiar during labor. The goal is not to select one “perfect” position in advance but to develop a range of options.
The bigger takeaway
This study adds to the growing conversation about mobility, bodily autonomy, and individualized support during childbirth.
Its findings suggest that upright positioning during the active second stage is associated with a greater likelihood of physiological birth. They also reinforce an important principle: a laboring woman should not automatically be placed on her back simply because it is the traditional or most convenient position for the care setting.
Birth positions should respond to the individual, the progression of labor, and the clinical circumstances. When it is safe to do so, supporting women to move, listen to their bodies, and explore upright positions may help create a more physiological and empowering birth experience.
Source: Tinker R, Catling C, Pigott K, et al. “Upright positions during the second stage of labour and birth outcomes: A prospective observational study.” Women and Birth. 2026;39(2):102184. Read the study abstract on PubMed.
This article is for educational purposes only and is not a substitute for individualized medical advice. Birth positions should be discussed with the attending healthcare team based on the circumstances of each labor.
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