Being in the hospital can be scary, you can feel like you “have” to do a lot of things because that’s the hospital’s culture. Today we’re going to talk about pushing positions and what you can and can’t do in the hospital?
But first, how do I know so much about pushing? Hi, I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I have helped thousands of moms push out their baby, and I also had 3 babies of my own — so I really understand how all of this works on both sides of the bed.
Come join me in my free beginning prenatal class where you can start taking the drivers seat for your delivery:
Ok, back to pushing. Remember that pushing is the 3rd stage of labour — and, on average, lasts about 2 hours.
I also have a YouTube video on this topic that you might enjoy watching:
You “Have” to Do Things In The Hospital
First off, let’s be REALLY clear about what you HAVE to do in the hospital or the delivery room.
There is absolutely nothing that you HAVE to do in the hospital.
As a hospital employee, the nurse is required to do things, but she can also chart your wishes and must allow you to do whatever you want.
That, however, does not stop you from having consequences of the choices you make.
If you don’t allow fetal monitoring, it doesn’t allow the staff to monitor for baby’s safety — which could lead to a poor outcome.
If you don’t allow us to take your blood pressure it could spike to dangerous levels which could have serious consequences.
If you choose to not push on your back you may have positive and/or negative benefits, which we will go over here.
Note: When you make choices in the hospital it is our DUTY (that is what you’re paying us for) to share the risks of the choices you are making. Many people feel like this is us pressuring them into making another choice — but if we were to end-up in court we would need to make it VERY clear that we informed you of the risks of your choice, and provided alternatives.
Moral: If you understand & are good with the risks of your choice, then you’re good to go. You understand the risks of getting in a car, but you likely do that frequently. Litigation is just so common in labor and delivery, we have to make those risks VERY clear.
When you know all of that going in — you’ll realize what the hospital is doing, and it isn’t pushing you to make one choice over another, it’s just informing you (remind yourself that if that seems pushy, to just let those thoughts pass and make the best choice for you at that time).
Reasons to Not Push On Your Back
There are reasons NOT to push on your back — let’s talk about them:
It’s Not Comfortable
Some women just don’t like laying flat on their back.
Likely, if you’re not comfortable you aren’t moving the baby well — so be sure to let your team know, so they can help you find a new position.
Some people find they have less use of pain medication if they are able to move more in the bed.
As a note, a lot of people ask why we tell you to not lie on your back during all of pregnancy, and then suddenly at the end it’s OK. The risk to squashing your vena cava is much less as the baby progresses into your pelvis. Also, often the nurse will still tilt you a small amount as you push so that major blood vessel won’t be compressed.
It May Increase Tearing
I am seeing physical therapists (on Tiktok mostly) saying that women are more likely to tear when they lay on their back. The thing is, physical therapists have never delivered a baby (nor are they trained to do so)…. so, I’m hesitant to take their opinion over a skilled OB.
I did read a couple of studies:
- This one shows that giving birth in stirrups does not increase your chance for tears. Hard to say if those women were still on their backs though.
- This study showed that pushing on your side (lateral position) was the most likely for no tears (with squatting being the most likely — which I’d agree with in my experience).
I will say that my worst tears have been when the patient just pushes crazy hard and blows-out the baby without any guidance from the providers.
As the baby descends past your perineum, your provider will likely encourage you to just give small pushes. That allows the perineum to stretch and allow the head through more easily. Then, as the shoulders come they can ask for a strong push. They can help guide you through the delivery. Good providers do this magnificently.
I have seen lots of women both tear and not tear while pushing on their backs.
I do think there could be some benefit to not opening the knees SO wide at delivery — that does seem to stretch the perineum a lot — so mention that to your providers (closed knee pushing is a thing as well — but you’ll want to see how your baby moves with that).
It Makes You Feel Uninvolved
You might feel more like a “patient” at this point. You can feel uninvolved and like we’re tying you down to have the baby. That’s not a good feeling — and we really don’t want that either!
Again, if you feel like that, talk with your providers so we can help you move into a place of empowerment. We really do want that.
It’s Not Allowing Baby to Descend
Sometimes the baby’s positioning isn’t compatible with you laying on your back. Perhaps your tailbone is in the way of the birth canal or baby needs to spin more (and being on your side will help that). If you’re pushing in a position for a long time without baby moving, you should all consider a different way to push. There really are a LOT of options, even with an epidural.
Alternatives to Pushing On Your Back in the Hospital Bed
I mean, the sky really is the limit:
If you don’t have an epidural:
- Sitting more upright
- Sitting on a birthing stool (if your hospital has one)
- Lunging at the bedside
- Toilet/commode pushing
- Hands and knees (up on all fours)
FYI these are just a few that came to mind as I was writing this — just think about what feels good to you at the time!
That is one of the BIG benefits to a home birth, those birthers are able to move all over the place and find their best positions.
Pro Tip: You may feel like you have to make BIG movements, but small pelvic movements can really make a change (and make you less tired).
If you have an epidural:
If you have an epidural (and it is working properly) you will likely not be able to hold up much of your body weight on your legs. This changes things a bit (these can also be used if you don’t have an epidural — obviously)
- Modified hands and knees holding onto the top of the bed — I’ve done this a bunch of times, but patients really only feel good about it for about 15 minutes, and then their pelvis starts to hurt because the muscles of the legs aren’t being helpful — but it can be great for a short period of time.
- Laying on your side
- Open kneed/closed kneed pushing
- Using the peanut ball between your legs as you push
- A more upright position
- The tug-of-war method (nurses can only tolerate this for so long as it’s hard on our backs to do this frequently).
Pro Tip: It helps your health care providers a lot if your family members get involved with helping to position you — it sometimes takes two, and having their support helps everyone (and makes them feel useful).
I think a lot of women feel like the staff should allow them to squat if they have an epidural but it really wouldn’t be safe. I have seen some patients do something similar to a squat in the bed, but patients can normally only tolerate it for a few minutes as it’s hard on your muscles that are working.
I know this sounds like a debbie downer, but if a patient has a good epidural, and can’t move her legs but tells me she wants to push in a position other than her back and just waits for me to move her (basically like a puppet) I am unlikely to have a lot of success.
It’s not your nurse’s job to hold you up (that’s really unsafe for both of you) or to move all your limbs. Make sure you engage in the process and do as much as you can to carry out your wishes.
Pro Tip: Try lots of different positions both in labor in birth. It can help you find some pain relief and often you have to try a few things to find your best birthing position.
In The Online Prenatal Class for Couples I actually have labor movement tip cards to help give you ideas of ways to labor and tips for partners to help you do it!
Reasons to Push On Your Back
A lot of women just enjoy how they’re able to rest more between contractions when they push on their back in a bed.
Remember, you’ll be pushing for about 1 out of every 3 minutes, so you do have 2’ish minutes where relaxing and gaining strength is your #1 goal. So, women really enjoy having the bed there to help them do that.
Some will be at the bedside for a time, and then choose to go in the bed for a bit. Changing positions is awesome, and don’t forget to allow yourself the rest that the bed may give you.
You Have an Epidural
If your epidural is super heavy, it is unlikely your nurse is going to help you into another position outside of the bed. We take patient falls really seriously and we could lose our license if that were to happen.
Remember, you can make the choices you want, but so can the nurse.
Now, just because you have an epidural doesn’t mean you have to just push in the stirrups and that’s that — lots of other things you can do.
Modifications to Pushing On Your Back
- Change how legs are positioned (open/close knees)
- Sit up higher with feet pushing on stirrups
- Move to your side and change how your legs are positioned (try straight, bent, etc)
- Use props like a stepstool or a peanut ball.
- Grab legs in different ways, or use the handles on the bed if they’re there
If you’re not loving a position, try and communicate to your team what you don’t love and we can work to find a better spot for you (communication is always the key!).
You have a Medical Condition that Requires It
If you are on magnesium sulfate, we are going to be extremely hesitant to get you out of the bed, just due to the side effects of that medication.
Things like a severe illness, or something like that could also require it.
Other complications can require that you birth in the bed, although they’re pretty rare.
Pro Tip: So often on social media I see people saying “always” or “should” but I think they’re not thinking about ALL the different types of patients with different complications, so always keep that in mind.
Your Practitioner Does Best That Way
You chose a specific doctor, and they were trained in a specific way how to deliver a baby. It, honestly, is just how deliveries are done in the United States and some western cultures (and have been that way for YEARS).
Some doctors really only know how to deliver a baby while mom is on their back. They provide the best guidance, they provide the best perineal pressure when mom is that way.
And frankly, a lot of people enjoy their birth experience on their back. So, they feel like it is a good idea.
They also may only know how to release a stuck shoulder, use forceps or a vacuum if you’re on your back. These can be emergency situations where they need to be extremely skilled and act quickly for possibly your life or the baby’s life.
I am hopeful that new doctors in residency are learning new ways — but ask your provider how often they deliver a patient not on their back. And then make the choice to stay with them, or to leave.
You have to think about it as any other skilled workman. If your gardener only knows how to mow the lawn in one direction with a specific mower — but you’re asking them to mow it in a new way with a different mower, you might not get as good of an outcome. I’m not sure that’s the best analogy, but you have to remember that doctors are just people with a specific skill set. When they recommend you deliver on your back, it is likely because they are best in that position.
Pro Tip: If you would like to deliver in another position, and your doctor seems hesitant, look to a midwife model of care. Certified Nurse Midwives (keep in mind that many people are “midwives” — but I only recommend a certified nurse midwife) are much more likely to deliver in you any position you want. They are also likely to take less high risk clients who need emergency services such as that mentioned above.
I am a HUGE fan of certified nurse midwives, I think they are the way of the future.
How Much Does Your Doctor/Midwife Do?
The good news in this situation is that your provider really only gets there at the very end. This means that before that time, you can move or try as many things as you want.
I will also say that I pushed with my patients in LOTS of positions, but as soon as the OB got there, they wanted them on their backs.
Keep in mind that’s what they wanted from me — and you can make the choice that’s best for you. You can ALWAYS say no — I want to deliver in xyz position.
You just have to accept the consequences of that choice. And those choices are always up to you.
What You’ll Do
I know it’s nice to think you’ll do things a specific way when you’re in labor (or when you’re a mom). That’s why you have a birth plan, right?
But when you’ve been in labor for hours, and you’re just so tired already, that bed may be a welcome place of refuge between contractions.
And THAT IS OK.
Tell your team that you’d like to promote movement as much as possible while still allowing you to relax between contractions quite a bit. Make sure that you’re putting in your A effort when they are helping you move, so that you can get in great spots that help you push like the She-Ra you are. 🙂
Perhaps you’ll have a burst of energy and want to try other things. Maybe you’ll try a squatting position for 15 minutes or so, and then move back to the bed (can I say any more how small changes like this can be AWESOME for you and moving that baby — and often pain relief as well).
Perhaps you’ll try something that sounded so perfect in your prenatal classes, but then find that it’s not comfortable, or that the baby isn’t moving in that spot — so you’ll adjust.
Personally, I try to get my patients to try a few (or many) positions so we can see what feels good to them — 99% of the time, the position my patient loved the most will be the position that moves the baby well also. And a good percentage of the time, we try a few positions that work well for them.
Just like ALL of labor, remember to be flexible and positive towards your birth and birth team. Have some ideas in mind about how you would like to push (both with and without an epidural) and then give it a whirl.
I bet no matter what happens, you’ll surprise yourself with the strength and grit that you have as you move your baby into this world. And frankly, you’re going to need all of those skills in parenthood. 🙂
Ok, what’s the next step now?
It’s time to take a prenatal class. Find one with someone with LOTS of experience, who is engaging and can get you BOTH prepared quickly — because I know you’re busy people. In fact, that’s entirely how I created my own class, and I can’t WAIT to see you in there! If you’re wondering if it’s as good as it sounds, check out the reviews.
And, if you’re not quite sure you’re ready for that whole thing, check out my free prenatal class. It’s your first step toward getting in the driver’s seat of your birth.
- About the Author
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A nurse since 1997, she has worked in various fields including pediatrics, geriatrics & hospice.
She has 20 years of labor and delivery experience in the San Jose, CA and Phoenix, AZ areas.