As a doula, one of your most important roles is helping the families you serve find comfort, progress, and empowerment during labor. One powerful way to support families is through using the best positions for labor and birth. Labor and birth positions can influence how labor progresses, how the baby moves through the pelvis, and how the birthing person copes with contractions.
If I could offer only one comfort tool to clients, it would be positioning and movement. It has such a profound role in how labor unfolds.
Here’s an evidence-based overview of ideal positions for labor and birth — and how doulas can use this knowledge to support physiologic birth and client autonomy.
Why Positioning Matters
Throughout training, you hear about the importance of positioning. Why is positioning so important during labor and birth? Position changes can:
- Encourage optimal fetal positioning
- Help labor progress more efficiently
- Reduce pain and pressure
- Lower the need for interventions like Pitocin or vacuum-assisted delivery
- Improve maternal satisfaction and sense of control
- Shorten second stage of labor
- Reduce the risk of cesarean
Staying upright and mobile is linked to shorter labors, fewer interventions, and improved outcomes — especially in low-risk, unmedicated births. But even with an epidural or high-risk birth, thoughtful positioning still matters. In fact, it is sometimes a birth with an epidural which can see the most benefit from position changes in terms of reducing the risk of assisted birth (e.g, vacuum, forceps, or c-section).
Best Labor Positions by Stage
As a doula, you know there are three stages of labor. The first stage, dilation, is broken into three phases. Early labor, active labor, and transition. The second stage of labor is pushing and the birth of baby. Third stage is when the placental is expelled.
Early Labor
Encourage rest, hydration, and gentle movement. Comfort is the priority here. Rest, distraction, and feelings of safety are helpful These positions are great for early labor:
- Side-lying with pillows
- Birth ball rocking or sitting
- Slow walks, lunges, and hip circles
- Hands-and-knees or child’s pose
- Rebozo belly sifting to relax ligaments
Doulas should observe the birthing person’s energy and emotional state. Often, being upright and gently active helps contractions become more regular. As a doula, it is important to help families know how to navigate early labor and which positions are ideal. Not all families will have the doula present during early labor.
Active Labor
Active labor is a great time for upright and forward-leaning positions to help baby descend and rotate. During active labor, many families will need to start using more comfort measures to cope with the increasing intensity of contractions.
Recommended positions:
- Standing and swaying
- Forward-leaning over a bed, chair, or birth ball
- Kneeling or hands-and-knees
- Lunges with one foot on a step or stool
- Toilet sitting (aka “dilation station”)
Encourage position changes every 30–60 minutes or based on baby’s station and the birthing person’s comfort. Movement can reduce back labor and help with fetal rotation. If someone is coping well with contractions and then they are suddenly struggling, it is often a sign a new position is needed.
Transition
This phase is intense and often overwhelming. While active positioning is still important, your client’s comfort may be the primary guide. Throughout most of labor, we follow the woman’s lead. She will almost always instinctively find the right position. However, transition can be overwhelming for some and guidance may be needed.
Helpful positions:
- Hands-and-knees to relieve pressure
- Side-lying for rest
- Leaning over a support person or ball
Doulas can use grounding touch, affirmations, breath coaching, and cool cloths to support emotionally through this intense stage. Double hip squeeze and counterpressure is also helpful during intense contractions.
Best Positions for Pushing (Second Stage)
Upright positions use gravity, open the pelvis, and promote more effective pushing. Supine (on the back) pushing is less effective and may reduce blood flow. We want to be sure the pelvis can open, tailbone can move out of the way, and the rhombus of Michaelis can make way for baby to descend. When in the supine position, the pelvis has less space for baby to descend.
Top evidence-based pushing positions:
- Squatting (supported or using a bar)
- Kneeling upright or on all fours
- Side-lying (especially useful with epidurals)
- Toilet or birthing stool
- Hands-and-knees (great for posterior babies)
Allowing clients to follow their instinctive pushing urges and move as they feel called can improve outcomes and satisfaction.
For the third stage, the placenta expelling, positioning is less important as it is simply tissue. Unlike the need for baby to rotate and fit through, the placenta is just a couple pounds of soft tissue.
Special Considerations
Every birth is unique. There are some things to consider which might impact which positions you recommend. Things to keep in mind:
- Epidural use: Side-lying, semi-sitting with a peanut ball, and supported squatting can all help keep labor progressing and baby engaged.
- Back labor: Rebozo techniques, hands-and-knees, and counterpressure can encourage rotation.
- Posterior baby: Forward-leaning, lunges, and asymmetrical positions can help reposition baby.
Final Tips for Doulas
Another thing to remember is always ask for consent before touching the birthing person. In addition, you want to:
- Always ask, “How does that feel?” Encourage the birthing person to listen to their body.
- Rotate positions regularly to prevent stagnation and fatigue.
- Use tools like the birth ball, peanut ball, rebozo, or squat bar to expand comfort and mobility options.
- Respect hospital protocols but advocate gently for movement and upright positions when safe and appropriate.
- Partner with providers. Nurses, midwives, and OBs may have helpful suggestions — work as a team!
As a doula, you can empower birthing people through movement and positioning. You don’t need to memorize every technique — just follow the person’s cues, stay flexible, and lean on your knowledge of how the body works in labor. With mindful positioning and emotional support, you can help create safer, smoother, and more satisfying birth experiences.
Not yet a trained and certified doula? Get started today and learn more about positioning during birth.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...