Emily Oster

7 min Read Emily Oster

Emily Oster

Labor Positions

The stages of labor and what position works best

Emily Oster

7 min Read

Not to overshare, but: when I gave birth to my first child, I pushed for over two hours. Or maybe it was four hours? Or a whole day? It blurs. Anyway, it was an extremely long time. I did it for the whole time on my back, in the “traditional” (for hospital births in the Western world in the modern era) position. I had a wonderful doula during the birth, and Jesse told me afterward he could tell she didn’t think much of the “pushing on your back” plan.

This approach of giving birth on your back, while common in the U.S., often comes under scrutiny. Some people argue this is only done to make it easier for medical providers and isn’t optimal for women. A closely related question is on positioning in early labor. Is lying in bed for the entire period of labor really the best option? Or would you be better off walking around?

Today, 12 years too late for me, I am going to answer the question of labor positioning. Was our doula right?

Stages of labor

Labor has three stages. The first is the part of labor when the cervix dilates to 10 centimeters. This is, itself, separated into stages: early labor, active labor, transition. The second stage of labor is the pushing stage, and the third is the delivery of the placenta. There’s a little graphic below to help show this. In general, the first stage of labor is the longest and the third is the shortest.

When we think about birth position, we’re really talking about the first and second stages. In the third stage, pretty much everyone is lying down (and it’s short).

A timeline showing the stages of labor and how long they last.

When we think about birth position, we’re really talking about the first and second stages. In the third stage, pretty much everyone is lying down (and it’s short).

Before we go further, it’s important to note that you don’t get to plan your labor. We may have preferences for how things go, but what happens is largely out of our control. You cannot plan the perfect labor just like you cannot “fail” at labor.

First stage of labor

During the first stage of labor, the key question is whether you will labor in bed or be able to walk around, sit on a ball, or do various other things. In some hospital-based birthing setups, laboring in bed is common. This is especially true with an epidural. Even without, in some cases a desire for continuous monitoring makes this approach common.

However: there is good evidence that labor is shorter and outcomes are improved when women are able to be upright and walking around during labor.

The best place to see this comprehensively is in this Cochrane review — a systematic meta-analysis of randomized controlled trials — that combines 25 randomized trials of about 5,200 women. The review is careful to note that not every trial in this set is ideal from a methodology perspective, and most are small.

Taken together, the trials show clear evidence of a shorter labor for women who are randomized to the upright, walking-around condition (rather than “care in bed”). The difference is about 1 hour and 20 minutes on average, with larger differences for first-time mothers. This difference is significant, and it’s a fairly long time.

The women randomized to the walking-around conditions were also less likely to have a cesarean section (about a 30% reduction on average across trials). On the other hand, there were no significant differences in infant outcomes.

What to take from this? It seems clear that if there is an option to walk around during labor, or do anything other than sit in bed, that is a good idea. This is more likely to be possible if you do not have an epidural, but at this point many epidurals can be done in a way that you can have at least some mobility.

Second stage of labor

In the second stage of labor, the question is slightly different. Typically people do not walk around during this labor stage, but there is still a question of position. You could push lying down or you can push upright, in a squatting position or similar. Is one better?

First, we can look at the length of time. The data here is not very consistent. There is a Cochrane review, and it includes 32 trials with about 9,000 women. But the results are inconsistent across trials, with some finding effects and some not. When they are averaged, the result is about a six-minute reduction in pushing time on average. For women who have an epidural, a review finds no evidence of a change in pushing time. Another paper, using a slightly different approach, finds a 20-minute reduction.

Generally, these effects are a lot smaller and less meaningful than the first-stage effects.

The other outcome of primary interest in the second stage of labor is perineal tearing. Here, the evidence is more mixed. There is some evidence that a squatting position during birth might slightly increase the risk of severe tears, but other review evidence doesn’t show a link. This is clearly significantly less important in determining tearing than things like baby size, whether there is an episiotomy performed, or baby position.

Bottom line: No position is obviously better or worse in this stage based on the data.

What about water birth?

As part of these conversations, sometimes people ask me about water birth. Is that a safe option? A better option?

This is the type of question where, before I even start looking into it, I know we will not have a good answer. Why not? It’s a rare and unusual choice. Most hospitals do not do it.

This makes it very unlikely that there are any randomized trials. And comparing women who had a water birth with those who did not is thorny and complicated. Even comparing people who planned a water birth with those who did not is an issue, because of differences in demographics. If we went further and compared those who actually achieved a water birth with those who did not, we are introducing all sorts of other biases.

Indeed, this literature really only focuses on trying to establish safety (generally it is safe, though infection is possible in very rare cases) and discussing whether women like this option among those who use it (which they do). There is no compelling evidence to suggest that water birth is either more painful or less painful. Basically, we do not know and I do not expect we will anytime soon.

Concluding thoughts

It was interesting to revisit this question with the benefit of hindsight. I think if I had all this information back in 2011, I would have been more aggressive about the need to walk around during labor, and maybe tried to influence the second-stage position.

Would it have mattered? Perhaps a bit. But it’s also a case where the effects are, in any event, small. There are some things during birth where the evidence is more compelling — the recommendation against routine episiotomy, for example. This is one where personal preference, and hospital constraints, are likely to be important factors alongside the data.

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👉Comment “Link” for a DM to an article that summarizes all of the best potty training advice we collected. 

Remember, you are not alone in the potty training struggle! It can be incredibly challenging, so please give yourself some grace.

#emilyoster #parentdata #pottytraining #pottytrainingtips #toddlertips

Looking for Memorial Day Weekend plans? Might be the perfect time to give potty training a shot. Potty training is notoriously difficult, and we unfortunately don’t have a lot of evidence-based guidance on what works best. So I asked the ParentData community to fill out a survey and share their knowledge — about 6,000 people responded.

👉Comment “Link” for a DM to an article that summarizes all of the best potty training advice we collected.

Remember, you are not alone in the potty training struggle! It can be incredibly challenging, so please give yourself some grace.

#emilyoster #parentdata #pottytraining #pottytrainingtips #toddlertips
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#emilyoster #funnytweets #relatabletweets #parentingjokes #kidssaythedarndestthings

Do you brand things a certain way to get your kid to accept it? Like calling carrots “rabbit popsicles”? Or telling them to put on their “super speed socks” in the morning? Share your rebrands in the comments below! You never know who you might be helping out 👇

#emilyoster #funnytweets #relatabletweets #parentingjokes #kidssaythedarndestthings
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Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

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Have you ever panic-googled a parenting question when everyone else is asleep? If so, you’re not alone.

Today is the first episode of a new biweekly series on my podcast: Late-Night Panic Google. On these mini-episodes, you’ll hear from some familiar names about the questions keeping them up at night, and how data can help. First up: @claireholt!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #emilyoster #claireholt #parentingstruggles #parentingtips #latenightpanicgoogle
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☀️ If you want to add a little sunscreen on their hands and feet? Go for it! But be mindful as baby skin tends to more prone to irritation.

Comment “Link” for a DM to an article on the data around sun and heat exposure for babies.

#sunsafety #babysunscreen #babyhealth #parentdata #emilyoster

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☀️ Keep them in the shade as much as possible when you’re out.
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☀️ If you want to add a little sunscreen on their hands and feet? Go for it! But be mindful as baby skin tends to more prone to irritation.

Comment “Link” for a DM to an article on the data around sun and heat exposure for babies.

#sunsafety #babysunscreen #babyhealth #parentdata #emilyoster
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OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio!

OUT NOW: My new book “The Unexpected: Navigating Pregnancy During and After Complications” is available on April 30th. All of my other books came out of my own experiences. I wrote them to answer questions I had, as a pregnant woman and then as a new parent. “The Unexpected” is a book not to answer my own questions but to answer yours. Specifically, to answer the thousands of questions I’ve gotten over the past decade from people whose pregnancies were more complicated than they had expected. This is for you. 💛 Order now at my link in bio! ...

Is side sleeping important during pregnancy? Comment “Link” for a DM to an article on whether sleep position affects pregnancy outcomes.

Being pregnant makes you tired, and as time goes by, it gets increasingly hard to get comfortable. You were probably instructed to sleep on your side and not your back, but it turns out that advice is not based on very good data.

We now have much better data on this, and the bulk of the evidence seems to reject the link between sleep position and stillbirth or other negative outcomes. So go ahead and get some sleep however you are most comfortable. 💤

Sources:
📖 #ExpectingBetter pp. 160-163
📈 Robert M. Silver et al., “Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes,” Obstetrics and Gynecology 134, no. 4 (2019): 667–76. 

#emilyoster #pregnancy #pregnancytips #sleepingposition #pregnantlife

Is side sleeping important during pregnancy? Comment “Link” for a DM to an article on whether sleep position affects pregnancy outcomes.

Being pregnant makes you tired, and as time goes by, it gets increasingly hard to get comfortable. You were probably instructed to sleep on your side and not your back, but it turns out that advice is not based on very good data.

We now have much better data on this, and the bulk of the evidence seems to reject the link between sleep position and stillbirth or other negative outcomes. So go ahead and get some sleep however you are most comfortable. 💤

Sources:
📖 #ExpectingBetter pp. 160-163
📈 Robert M. Silver et al., “Prospective Evaluation of Maternal Sleep Position Through 30 Weeks of Gestation and Adverse Pregnancy Outcomes,” Obstetrics and Gynecology 134, no. 4 (2019): 667–76.

#emilyoster #pregnancy #pregnancytips #sleepingposition #pregnantlife
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#pregnancy #pregnancycomplications #pregnancyjourney #preeclampsiaawareness #postpartumjourney #emilyoster

My new book, “The Unexpected: Navigating Pregnancy During and After Complications” is available for preorder at the link in my bio!

I co-wrote #TheUnexpected with my friend and maternal fetal medicine specialist, Dr. Nathan Fox. The unfortunate reality is that about half of pregnancies include complications such as preeclampsia, miscarriage, preterm birth, and postpartum depression. Because these are things not talked about enough, it can not only be an isolating experience, but it can also make treatment harder to access.

The book lays out the data on recurrence and delves into treatment options shown to lower risk for these conditions in subsequent pregnancies. It also guides you through how to have productive conversations and make shared decisions with your doctor. I hope none of you need this book, but if you do, it’ll be here for you 💛

#pregnancy #pregnancycomplications #pregnancyjourney #preeclampsiaawareness #postpartumjourney #emilyoster
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We are better writers than influencers, I promise. Thanks to our kids for filming our unboxing videos. People make this look way too easy. 

Only two weeks until our book “The Unexpected” is here! Preorder at the link in my bio. 💙

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Only two weeks until our book “The Unexpected” is here! Preorder at the link in my bio. 💙
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This is why good data is so important! When we can trust the data, we can trust our choices. And this study shows there is no blame to be placed on pregnant women here. So if you have a migraine or fever, please take your Tylenol.

#tylenol #pregnancy #pregnancyhealth #pregnancytips #parentdata #emilyoster

Exciting news! We have new, high-quality data that says it’s safe to take Tylenol during pregnancy and there is no link between Tylenol exposure and neurodevelopmental issues in kids. Comment “Link” for a DM to an article exploring this groundbreaking study.

While doctors have long said Tylenol was safe, confusing studies, panic headlines, and even a lawsuit have continually stoked fears in parents. As a result, many pregnant women have chosen not to take it, even if it would help them.

This is why good data is so important! When we can trust the data, we can trust our choices. And this study shows there is no blame to be placed on pregnant women here. So if you have a migraine or fever, please take your Tylenol.

#tylenol #pregnancy #pregnancyhealth #pregnancytips #parentdata #emilyoster
...