Alternate Birthing Positions: Upright, Side-Lying & Supported Positions

WHO-aligned approach

There is no single position that every woman must use

WHO recommends mobility and upright positioning during labour for women at low risk and recommends supporting a woman's individual choice of birth position, including upright positions. The position should not be forced, and maternal and fetal wellbeing must continue to be assessed.

Freedom to move

Mobility can allow a woman to change position in response to contractions, comfort and fatigue.

Comfort & control

Being able to choose a comfortable position can support a woman’s sense of control and positive birth experience.

Supported care

A birth companion and skilled maternity professional can help with safe position changes and comfort measures.

Ongoing assessment

Position choice should occur alongside appropriate maternal and fetal assessment throughout labour and birth.

Key principle: a position is not “better” simply because it is upright. The appropriate position depends on the woman's preference, comfort, stage of labour, analgesia, maternal and fetal condition, monitoring needs and the availability of skilled support.

Position guide

Common labour and birth positions

These positions can be adapted with pillows, a bed, chair, rail, birth stool, companion or other appropriate support. Availability differs between maternity facilities.

Upright

Standing

Standing can allow free movement and may feel comfortable during contractions or while changing position.

Mobility

Walking

For women at low risk, walking and changing position during labour can be encouraged when clinically appropriate.

Supported

Supported sitting

Sitting on a chair, birth stool or other suitable support can provide rest while maintaining an upright posture.

Resting

Side-lying

Side-lying can provide comfort and rest and may be useful when an upright position is tiring or not preferred.

All-fours

Hands-and-knees

An all-fours or hands-and-knees position may be comfortable for some women during labour or birth.

Supported

Kneeling

Kneeling, including supported kneeling, may allow movement and a comfortable forward-leaning posture.

Resting

Semi-recumbent

A semi-recumbent position can combine support and some upright posture, especially when a woman needs to rest.

Upright

Squatting with support

Supported squatting can be an option for some women where suitable equipment, space and skilled assistance are available.

Choice

Woman’s preferred position

There is no single position that every woman must use. Preference should be considered together with clinical safety.

During labour

Movement can be part of supportive labour care

For women at low risk, WHO recommends encouraging mobility and an upright position during labour. Position changes can be used according to comfort, preference and clinical circumstances.

When a position may feel useful

During contractions when a woman wants to move or change position.
When standing, walking or leaning forward feels more comfortable than lying down.
When resting is needed and side-lying or semi-recumbent positioning is preferred.
During second stage when a woman wants an upright, side-lying or other comfortable birth position.
When a support person, birth stool, bed or other equipment can safely assist the preferred position.

Practical ways to change position

Discuss preferred labour and birth positions during antenatal care when possible.
Tell the maternity team which positions feel comfortable and which positions you would prefer to avoid.
Change position according to comfort, fatigue and the clinical situation.
Use support from a companion, bed, rail, chair, birth stool or other suitable equipment when available.
Keep hydration, privacy, communication and comfort in mind while changing positions.
If monitoring or a procedure requires a different position, ask the maternity team to explain why.
Never force a woman into a position she does not want unless an urgent clinical situation requires immediate action.

Companion support

A companion can provide emotional support and practical assistance, such as helping with a supported standing, leaning or kneeling position, when permitted by the maternity facility and safe for the woman.

Second stage of labour

Birth position should support comfort, choice and safety

WHO recommends a birth position of the woman's individual choice, including upright positions, both for women without epidural analgesia and for women with epidural analgesia, when clinically appropriate.

Without epidural analgesia

WHO recommends encouraging a birth position chosen by the woman, including upright positions, when clinically appropriate.

With epidural analgesia

WHO also recommends supporting a woman to choose a birth position, including upright positions, when clinically appropriate and when safe mobility is possible.

Do not force a position

The woman should not be forced into a particular birth position. The maternity team should support the position she finds most comfortable while maintaining appropriate monitoring.

Explain necessary changes

If a position needs to change to allow adequate fetal monitoring or another clinical intervention, the reason should be clearly communicated whenever circumstances allow.

WHO evidence note: available evidence suggests upright positions may reduce episiotomy and instrumental vaginal birth in some settings, but may also be associated with increased second-degree tears and postpartum haemorrhage. Much of the evidence is of low certainty, so women should be supported in choosing a comfortable position rather than being directed into one “best” position.

Clinical safety

When the maternity team may recommend changing position

Position choice remains part of individualized care, but clinical circumstances can require temporary or permanent changes.

Important considerations

Maternal condition and vital signs.
Fetal wellbeing and the ability to monitor the baby adequately.
Stage and progress of labour.
Presence or absence of epidural or other analgesia.
Intravenous lines, urinary catheter, monitoring equipment or other procedures.
Bleeding, severe pain, abnormal fetal heart findings or other complications.
The availability of skilled assistance and suitable equipment.

Communication matters

Explain why a position change is recommended whenever possible.
Respect the woman's preference when there is no clinical reason to restrict it.
Maintain privacy and dignity during position changes.
Use appropriate assistance when the woman has reduced mobility.
Continue appropriate maternal and fetal assessment.

Monitoring is more important than the position label

A woman can use a preferred position only while it remains compatible with her safety and the baby's wellbeing. If monitoring becomes inadequate, the team should adapt the position or monitoring method and explain the reason whenever possible.

Position through labour

Position choice can change as labour changes

01

Early labour

Walking, standing, leaning and other comfortable positions may support mobility and coping with contractions.

02

Active labour

Position changes can continue according to comfort, fatigue, analgesia and clinical assessment.

03

Second stage

The woman can be supported to choose a comfortable birth position, including upright positions when appropriate.

04

After birth

Positioning should support safe maternal recovery, newborn assessment, skin-to-skin contact and early breastfeeding when appropriate.

Comfort strategies

Positions can be combined with other supportive measures

Position changes are one part of labour support. WHO also recommends evidence-informed comfort and pain-relief approaches according to individual preference and clinical circumstances.

Breathing & relaxation

Breathing, relaxation, music, mindfulness and other techniques may be used according to the woman's preference.

Massage & warm packs

Manual comfort techniques such as massage or warm packs may be useful for women requesting pain relief.

Continuous support

Emotional support from a chosen companion and maternity professional can help a woman cope with labour and position changes.

Urgent safety information

Seek immediate maternity or emergency assessment when needed

Position changes should never delay assessment or treatment of a serious maternal or fetal concern.

Do not wait for a routine appointment if:

Heavy vaginal bleeding.
Severe or persistent abdominal pain or another severe new symptom.
Fainting, collapse, convulsions or markedly altered consciousness.
Severe breathing difficulty or chest pain.
A concerning change in fetal movement before birth.
Fever or severe illness with concerning symptoms.
Any abnormal finding identified by the maternity team.
Any situation in which the woman feels something is seriously wrong.

Frequently asked questions

Alternate birthing positions FAQs

What are alternate birthing positions?

Alternate birthing positions are positions other than lying flat on the back. They may include upright standing, walking, supported sitting, side-lying, kneeling, hands-and-knees, semi-recumbent and supported squatting. WHO recommends that women be supported to choose a comfortable birth position, including upright positions, when clinically appropriate.

Is an upright position recommended during labour?

Yes. For women at low risk, WHO recommends encouraging mobility and an upright position during labour. The appropriate position still depends on the individual clinical situation.

Can I choose my own birth position?

WHO recommends supporting women to adopt a birth position of their individual choice, including upright positions. The choice should be supported by the maternity team while maintaining appropriate maternal and fetal assessment.

Can I use an alternate position if I have an epidural?

WHO also recommends supporting a woman with epidural analgesia to adopt a birth position of her choice, including upright positions, when clinically appropriate. Actual mobility depends on the type and dose of analgesia, monitoring, motor function, facility policy and clinical assessment.

Is squatting always better than lying down?

No. There is no single best position for every woman. Upright positions may have potential benefits and potential harms, and the certainty of some evidence is low. The woman should be supported to use a comfortable position appropriate to her circumstances rather than being forced into a particular position.

Can I change positions during labour?

Yes. Changing positions according to comfort is commonly part of supportive labour care for women who are clinically stable. The maternity team may recommend a change when monitoring, treatment or a complication requires it.

What if the baby needs continuous monitoring?

The maternity team should choose monitoring methods and positions that maintain adequate assessment of fetal wellbeing. If a particular position interferes with monitoring, the reason for changing position should be explained whenever possible.

Does an alternate position guarantee a normal vaginal birth?

No. Position can support comfort and mobility, but it cannot guarantee a particular mode of birth. Labour management depends on maternal and fetal condition, labour progress and any complications that develop.

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Guideline references

Evidence sources

This page is based primarily on WHO intrapartum-care recommendations. National, state and facility protocols may add requirements or modify implementation according to local resources and clinical circumstances.

Medical information disclaimer: This page is for general education and does not replace individualized assessment, diagnosis or treatment by a qualified maternity-care professional. The safest position depends on the woman's health, pregnancy, labour progress, fetal condition, analgesia, monitoring and available clinical support. In an emergency, seek immediate local maternity or emergency care.