Switching Up Push Positions With an Epidural?!

If you’re planning to get an epidural during birth, you might be wondering how that affects your ability to move and push. Many people assume that once the epidural is in, you’ll be confined to lying flat on your back — but that’s not the full story! Even with an epidural, there are creative and effective birth positions that can support your pelvic floor, help your baby descend, and make pushing more efficient.

As a expert pelvic floor physical therapists, we often work with clients who want to understand how to optimize their birth experience — including what positions are possible (and beneficial!) when sensation or mobility is limited. In this post, we’ll explore how switching up pushing positions with an epidural can protect your pelvic floor, improve comfort, and empower you to stay active and involved in your birth.

Delivery positions other than lithotomy (on your back) can help you have a smoother delivery with less to recover from

During labor and delivery, adopting various positions—such as standing, squatting, kneeling, or using a birthing stool—can offer several advantages over lying on your back:

1. Facilitates Labor Progression: Upright positions, including standing, walking, or using a birthing ball, utilize gravity to assist the baby's descent through the birth canal. This natural aid can lead to a shorter labor by promoting more effective contractions and reducing the need for interventions. Research indicates that staying upright during early and active labor can reduce the need for a cesarean section and decrease the duration of labor.

2. Enhances Pelvic Opening: Positions like squatting, kneeling, or lunging can widen the pelvis, creating more space for the baby to move down. This can make the pushing stage more efficient and may reduce the need for interventions. For example, squatting opens the pelvis by approximately 28%, facilitating the baby's descent. 

3. Improves Comfort and Pain Management: Changing positions during labor can help manage pain and make you feel more in control. Some research suggests that certain positions may be useful in moving labor along. For instance, leaning forward during contractions can help the uterus contract more efficiently, aiding in pain management. Additionally, upright positions can stimulate the release of endorphins, the body's natural pain relievers, enhancing comfort during labor. 

4. Encourages Optimal Fetal Positioning: Certain positions can help the baby move into the optimal head-down, facing the mother's back position, which can facilitate a smoother delivery. Positions such as hands and knees or side-lying can encourage the baby to rotate into the ideal position for birth. This optimal positioning can reduce the risk of complications during delivery and may lead to a quicker and less painful birth experience. 

5. Reduces Back Pain: Lying on your back can increase pressure on the back and spine, leading to discomfort. Upright positions can alleviate this pressure and reduce back pain during labor. For example, using a birthing ball allows for gentle movement and can help relieve back pain. Additionally, positions like hands and knees can help relieve back pain by shifting the baby's weight off the spine.

Push positioning, perineal stretching, and push breathing are all instructed in your delivery prep program!

6. Enhances Maternal Satisfaction: Allowing the birthing person to choose positions that feel most comfortable can lead to a more positive birth experience. When individuals feel in control and can move freely, it can reduce feelings of anxiety and increase overall satisfaction with the birth process. This sense of control can also contribute to a quicker recovery postpartum. Moreover, a positive birth experience can have long-term benefits for maternal mental health.

7. Potentially Shortens the Second Stage of Labor: Some studies suggest that upright positions during the pushing phase can shorten the duration of the second stage of labor, leading to a quicker delivery. For instance, squatting can increase the pelvic diameter, allowing the baby to descend more rapidly. This can reduce the need for interventions such as forceps or vacuum extraction and may lead to a more straightforward delivery. 

8. Promotes Effective Contractions: Certain positions can help the uterus contract more effectively, which can aid in the progression of labor. For example, leaning forward during contractions can help the uterus contract more efficiently, aiding in pain management. Additionally, positions like hands and knees can help the uterus contract more effectively by allowing the baby to move into a more favorable position. 

9. Increases Blood Flow: Upright positions can improve blood circulation, ensuring that both mother and baby receive adequate oxygen and nutrients during labor. This can contribute to better overall health during the birthing process. Improved circulation can also help in reducing swelling and fatigue. Furthermore, better blood flow can enhance the efficiency of contractions, aiding in the progression of labor.

10. Provides Greater Mobility: Being upright and mobile during labor allows the birthing person to change positions as needed, which can help cope with contractions and facilitate the baby's descent. This mobility can also help prevent complications associated with prolonged immobility, such as deep vein thrombosis. Additionally, moving freely can help in finding positions that provide the most comfort and support during labor. This adaptability can lead to a more positive and empowering birth experience. 

Listen to your body and try a few different positions; you'll have some you love and some you don't in the moment!

Push Positions With Epidural

While these positions can be super helpful, it’s always a good idea to chat with your healthcare team about what feels right and safe for you and your baby.

Even with an epidural, you’ve still got options! Although it can limit some movement, there are still plenty of creative ways to switch things up, stay comfortable, and help your body and baby work together. Here are a few positions worth exploring as you prepare for birth:

1. Side-Lying

Side-lying is one of the most comfortable and pelvic floor–friendly positions with an epidural. Lying on your side with a pillow between your knees keeps your pelvis aligned and encourages gentle internal rotation — helping your pelvic floor stay relaxed and supportive. It’s also a great option if you need rest between pushes while still keeping labor progressing.

2. Throne (Semi-Upright)

Think of this as the “relaxed upright” position! With the bed adjusted like a chair, your torso stays elevated, allowing gravity to lend a hand while still keeping you well supported. This position opens the pelvic outlet and can improve pushing efficiency — plus, it’s a great balance of comfort and control.

3. Supine (On Your Back)

The traditional on-your-back position can still be functional with some pelvic floor–friendly adjustments. Try tilting the bed slightly or placing a small wedge or towel roll under your hips to give your sacrum room to move. This helps your pelvic floor and core work together, instead of pushing against a flat surface.

4. All-Fours / Kneeling on the Bed

If your epidural allows some mobility, being on hands and knees can be a total game changer. This position encourages optimal pelvic expansion and can relieve pressure on the tailbone. You can rest your chest on a birth ball, the back of the bed, or pillows to stay supported — great for rotation or repositioning of baby, too.

5. Supported Squat

When you’re ready for a bit more engagement, a supported squat can help your baby descend through the pelvis. With a bar or partner for balance, you can open the hips and use gravity effectively — even if your legs are partially numb. This position isn’t always ideal for the actual delivery, but it can be amazing for labor progress.

6. “Tug-of-War” Push

For an empowering variation, try the tug-of-war push! Holding onto a rebozo, sheet, or strap, you pull while pushing, activating your arms, lats, and core — which helps engage your whole body and coordinate a strong, effective push. It’s a great way to connect with your power, even with limited lower-body mobility.

Trying different push positions with an epidural leads to a smoother delivery with fewer things to recover from!

If you’re expecting and want personalized guidance, our Delivery Prep Program is designed to help you learn positions, breathing strategies, perineal stretching, and pelvic floor techniques tailored to your body and birth plan. Click here to schedule your Delivery Prep session and start feeling confident, informed, and empowered for birth!