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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Milestones. We celebrate them in pregnancy, in parenting, and they’re a fun thing to celebrate at work too. Just a couple years ago I couldn’t have foreseen what this community would grow into. Today, there are over 400,000 of you here—asking questions, making others feel seen wherever they may be in their journey, and sharing information that supports data > panic. 

It has been a busy summer for the team at ParentData. I’d love to take a moment here to celebrate the 400k milestone. As I’ve said before, it’s more important than ever to put good data in the hands of parents. 

Share this post with a friend who could use a little more data, and a little less parenting overwhelm. 

📷 Me and my oldest, collaborating on “Expecting Better”

Milestones. We celebrate them in pregnancy, in parenting, and they’re a fun thing to celebrate at work too. Just a couple years ago I couldn’t have foreseen what this community would grow into. Today, there are over 400,000 of you here—asking questions, making others feel seen wherever they may be in their journey, and sharing information that supports data > panic.

It has been a busy summer for the team at ParentData. I’d love to take a moment here to celebrate the 400k milestone. As I’ve said before, it’s more important than ever to put good data in the hands of parents.

Share this post with a friend who could use a little more data, and a little less parenting overwhelm.

📷 Me and my oldest, collaborating on “Expecting Better”
...

I spend a lot of time talking people down after they read the latest panic headline. In most cases, these articles create an unnecessary amount of stress around pregnancy and parenting. This is my pro tip for understanding whether the risk presented is something you should really be worrying about.

Comment “link” for an article with other tools to help you navigate risk and uncertainty.

#emilyoster #parentdata #riskmanagement #parentstruggles #parentingstruggles

I spend a lot of time talking people down after they read the latest panic headline. In most cases, these articles create an unnecessary amount of stress around pregnancy and parenting. This is my pro tip for understanding whether the risk presented is something you should really be worrying about.

Comment “link” for an article with other tools to help you navigate risk and uncertainty.

#emilyoster #parentdata #riskmanagement #parentstruggles #parentingstruggles
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Here’s why I think you don’t have to throw away your baby bottles. ...

Drop your toddlers favorite thing right now in the comments—then grab some popcorn.

Original thread source: Reddit @croc_docs

Drop your toddlers favorite thing right now in the comments—then grab some popcorn.

Original thread source: Reddit @croc_docs
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Just keep wiping.

Just keep wiping. ...

Dr. Gillian Goddard sums up what she learned from the Hot Flash  S e x  Survey! Here are some key data takeaways:

🌶️ Among respondents, the most common s e x u a l frequency was 1 to 2 times per month, followed closely by 1 to 2 times per week
🌶️ 37% have found their sweet spot and are happy with the frequency of s e x they are having
🌶️ About 64% of respondents were very or somewhat satisfied with the quality of the s e x they are having

Do any of these findings surprise you? Let us know in the comments!

#hotflash #intimacy #midlifepleasure #parentdata #relationships

Dr. Gillian Goddard sums up what she learned from the Hot Flash S e x Survey! Here are some key data takeaways:

🌶️ Among respondents, the most common s e x u a l frequency was 1 to 2 times per month, followed closely by 1 to 2 times per week
🌶️ 37% have found their sweet spot and are happy with the frequency of s e x they are having
🌶️ About 64% of respondents were very or somewhat satisfied with the quality of the s e x they are having

Do any of these findings surprise you? Let us know in the comments!

#hotflash #intimacy #midlifepleasure #parentdata #relationships
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Here’s what we know from a data standpoint:
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✈️ A JAMA Pediatrics paper estimates about 0.4 child air crash deaths per year might be prevented in the U.S. with car seats 
✈️ Cars are far more dangerous than airplanes! The same JAMA paper suggests that if 5% to 10% of families switched to driving, then we would expect more total deaths as a result of this policy. 

If you want to buy a seat for your lap infant, or bring a car seat for an older child, by all means do so! But the additional protection based on the numbers is extremely small.

#parentdata #emilyoster #flyingwithkids #flyingwithbaby #carseats #carseatsafety

Should your kid be in a car seat on the plane? The AAP recommends that you put kids under 40 pounds into a car seat on airplanes. However, airlines don’t require car seats.

Here’s what we know from a data standpoint:
✈️ The risk of injury to a child on a plane without a carseat is very small (about 1 in 250,000)
✈️ A JAMA Pediatrics paper estimates about 0.4 child air crash deaths per year might be prevented in the U.S. with car seats
✈️ Cars are far more dangerous than airplanes! The same JAMA paper suggests that if 5% to 10% of families switched to driving, then we would expect more total deaths as a result of this policy.

If you want to buy a seat for your lap infant, or bring a car seat for an older child, by all means do so! But the additional protection based on the numbers is extremely small.

#parentdata #emilyoster #flyingwithkids #flyingwithbaby #carseats #carseatsafety
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SLEEP DATA 💤 PART 2: Let’s talk about naps. Comment “Link” for an article on what we learned about daytime sleep!

The first three months of life are a chaotic combination of irregular napping, many naps, and a few brave or lucky souls who appear to have already arrived at a two-to-three nap schedule. Over the next few months, the naps consolidate to three and then to two. By the 10-to-12-month period, a very large share of kids are napping a consistent two naps per day. Over the period between 12 and 18 months, this shifts toward one nap. And then sometime in the range of 3 to 5 years, naps are dropped. What I think is perhaps most useful about this graph is it gives a lot of color to the average napping ages that we often hear. 

Note: Survey data came from the ParentData audience and users of the Nanit sleep monitor system. Both audiences skew higher-education and higher-income than the average, and mostly have younger children. The final sample is 14,919 children. For more insights on our respondents, read the full article.

SLEEP DATA 💤 PART 2: Let’s talk about naps. Comment “Link” for an article on what we learned about daytime sleep!

The first three months of life are a chaotic combination of irregular napping, many naps, and a few brave or lucky souls who appear to have already arrived at a two-to-three nap schedule. Over the next few months, the naps consolidate to three and then to two. By the 10-to-12-month period, a very large share of kids are napping a consistent two naps per day. Over the period between 12 and 18 months, this shifts toward one nap. And then sometime in the range of 3 to 5 years, naps are dropped. What I think is perhaps most useful about this graph is it gives a lot of color to the average napping ages that we often hear.

Note: Survey data came from the ParentData audience and users of the Nanit sleep monitor system. Both audiences skew higher-education and higher-income than the average, and mostly have younger children. The final sample is 14,919 children. For more insights on our respondents, read the full article.
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Tag a Dad who this holiday may be tricky for. We’re sending you love. 💛

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Tag a Dad who this holiday may be tricky for. We’re sending you love. 💛
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#parentdata #postpartum #postpartumdepression #paternalmentalhealth #newparents #emilyoster

“Whilst googling things like ‘new dad sad’ and ‘why am I crying new dad,’ I came across an article written by a doctor who had trouble connecting with his second child. I read the symptoms and felt an odd sense of relief.” Today we’re bringing back an essay by Kevin Maguire of @newfatherhood about his experience with paternal postpartum depression. We need to demystify these issues in order to change things for the better. Comment “Link” for a DM to read his full essay.

#parentdata #postpartum #postpartumdepression #paternalmentalhealth #newparents #emilyoster
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#emilyoster #parentdata #parentingcommunity #lookslikedaddy #lookslikemommy

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#emilyoster #parentdata #parentingcommunity #lookslikedaddy #lookslikemommy
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This graph shows sleeping location by age. You’ll notice that for the first three months, most kids are in their own sleeping location in a parent’s room. Then, over the first year, this switches toward their own room. As kids age, sharing a room with a sibling becomes more common. 

Head to the newsletter for more and stay tuned for part two next week on naps! 🌙

#parentdata #emilyoster #childsleep #babysleep #parentingcommunity

SLEEP DATA 💤 We asked you all about your kids’ sleep—and got nearly 15,000 survey responses to better understand kids’ sleep patterns. Comment “Link” for an article that breaks down our findings!

This graph shows sleeping location by age. You’ll notice that for the first three months, most kids are in their own sleeping location in a parent’s room. Then, over the first year, this switches toward their own room. As kids age, sharing a room with a sibling becomes more common.

Head to the newsletter for more and stay tuned for part two next week on naps! 🌙

#parentdata #emilyoster #childsleep #babysleep #parentingcommunity
...

Weekends are good for extra cups of ☕️ and listening to podcasts. I asked our team how they pod—most people said on walks or during chores. What about you?

Comment “Link” to subscribe to ParentData with Emily Oster, joined by some excellent guests.

#parentdata #parentdatapodcast #parentingpodcast #parentingtips #emilyoster

Weekends are good for extra cups of ☕️ and listening to podcasts. I asked our team how they pod—most people said on walks or during chores. What about you?

Comment “Link” to subscribe to ParentData with Emily Oster, joined by some excellent guests.

#parentdata #parentdatapodcast #parentingpodcast #parentingtips #emilyoster
...

Humility. That’s why. That’s the whole reason.

#emilyoster #secondbaby #parentingjokes #parentinghumor

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#emilyoster #secondbaby #parentingjokes #parentinghumor
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Prevention is key! I suggest:
⭐ Regular tick checks
⭐ Using bug sprays with DEET 
⭐ Wearing long sleeves and pants in the woods

Some parents worry about DEET, but repellants with up to 30% DEET are recommended by both the CDC and AAP. The data says you’re in the clear, so go for it. Enjoy your summer!

#parentdata #emilyoster #tickseason #bugbites #bugspray

Bug season is upon us. Besides annoyance, this can bring up safety concerns, particularly with ticks. They are carriers of diseases, most notably Lyme disease. So what’s the best course of action?

Prevention is key! I suggest:
⭐ Regular tick checks
⭐ Using bug sprays with DEET
⭐ Wearing long sleeves and pants in the woods

Some parents worry about DEET, but repellants with up to 30% DEET are recommended by both the CDC and AAP. The data says you’re in the clear, so go for it. Enjoy your summer!

#parentdata #emilyoster #tickseason #bugbites #bugspray
...