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Is there really a best position to give birth in? A major Cochrane review involving 9,015 women found that, among women giving birth without epidural anaesthesia, upright positions were associated with fewer assisted vaginal births and a slightly shorter second stage of labour — but also with some possible trade-offs. More recent evidence suggests position matters, but there is still no single position that is best for every birth.
Standing.
Sitting.
Kneeling.
Squatting.
Lying on the side.
Semi-reclining.
Or lying on the back.
For something humans have been doing for thousands of years, the question sounds surprisingly simple:
What is actually the best position to give birth in?
The evidence does not give us one universal winner.
What it does show is more interesting.
Birth position can influence the mechanics and experience of labour, and different positions may be associated with different outcomes. But epidural use, individual anatomy, fetal position, maternal comfort, clinical circumstances and the stage of labour can all change the answer.
The most useful conclusion is therefore not:
“Every woman should give birth upright.”
Nor is it:
“Lying down is the safest position.”
It is:
When clinically appropriate, childbirth environments should allow position to change rather than assuming that one posture fits every woman and every birth.
WHO's current implementation guidance similarly recommends supporting a woman's choice of birth position — including upright positions — both with and without epidural analgesia, while emphasizing that no particular position should be forced.
Quick Answer: What Is the Best Position to Give Birth In?
There is no single evidence-based birth position that is best for everyone.
For women without an epidural, evidence suggests upright positions such as standing, kneeling, sitting or squatting may reduce assisted vaginal births and episiotomy and may slightly shorten the second stage of labour.
However, some studies have also found higher measured blood loss and a possible increase in second-degree perineal tears.
The overall certainty of evidence varies substantially.
For women with an epidural, the picture is different.
A Cochrane review involving 4,464 women found no clear overall advantage of upright over recumbent positions for operative birth, while higher-quality evidence within the review suggested that appropriate lying-down positions — particularly side-lying rather than flat on the back — may sometimes produce better outcomes.
The practical answer is therefore:
The best position is often the clinically appropriate position that the woman finds comfortable and can safely use at that stage of labour.
What Did the Study of 9,015 Births Actually Find?
The number in the headline comes from a Cochrane systematic review examining birth position during the second stage of labour in women without epidural anaesthesia.
Thirty randomized trials contributed data from 9,015 women.
Researchers compared upright positions with supine or recumbent positions.
The results were not simply:
“Upright is better.”
They were mixed.
Women using upright positions had a second stage of labour that was, on average, about 6 minutes shorter.
But the quality of evidence for this result was rated very low, and when high-risk-of-bias studies were removed, the difference was no longer clearly statistically significant.
The reduction in assisted vaginal delivery was more convincing.
Upright positions were associated with a relative risk of 0.75, meaning assisted births such as forceps or vacuum delivery occurred less frequently in the upright groups in those studies.
Evidence for this outcome was rated moderate quality.
There was no clear difference in Caesarean-section rates.
Episiotomies were less frequent in upright positions, but second-degree perineal tears may have been somewhat more common.
Women in upright positions were also more likely to have measured blood loss of 500 mL or more, although the researchers noted that differences in how blood loss was measured may partly explain that finding.
That combination is exactly why birth-position evidence should not be compressed into a social-media claim such as:
“Squatting is scientifically proven to be the best way to give birth.”
It is not.
Six Minutes Shorter: Is That Actually Important?
Probably less than the headline number makes it sound.
A six-minute average reduction in the second stage of labour is statistically interesting, but it may not be clinically transformative for every woman.
And the evidence supporting that specific difference was very low certainty.
The more important finding may be that changing position appears capable of influencing several different parts of the birth process, rather than merely reducing the clock.
That includes possible effects on:
assisted delivery,
episiotomy,
perineal trauma,
blood loss,
maternal comfort,
and potentially fetal heart-rate patterns.
No single outcome should be looked at in isolation.
A position that reduces the duration of labour by a few minutes but creates another disadvantage is not automatically “better.”
What Counts as an Upright Birth Position?
“Upright” does not mean that a woman must literally stand while giving birth.
Research groups several positions under the upright category.
These can include:
sitting on a bed or birth stool,
kneeling upright,
hands and knees,
standing,
supported standing,
and squatting.
Different researchers group positions differently, which is one reason birth-position studies can be difficult to compare.
A semi-seated position may be classified differently from a truly vertical position.
Hands-and-knees is mechanically different from standing.
Squatting is different again.
So asking whether:
“upright birth is better”
combines several very different body positions into one label.
What Is the Supine Position During Birth?
The supine position usually means lying on the back.
But birth research often groups several recumbent positions together, including:
fully supine,
semi-recumbent,
lateral or side-lying,
and lithotomy.
These are not interchangeable.
Side-lying is particularly important to separate from lying flat on the back.
NICE guidance advises women in the second stage of labour that lying flat on the back can lower blood pressure and may reduce placental blood flow.
For women with an epidural, NICE specifically notes that lying on the side may increase the chance of spontaneous vaginal birth while still allowing other comfortable positions, including upright positions.
So:
lying down does not necessarily mean lying flat on the back.
That distinction becomes important when reading studies or birth advice online.
What Is the Lithotomy Position?
Lithotomy is the familiar hospital-birth position in which the woman lies on her back or is semi-reclined while her legs are elevated and supported.
It can provide clinicians with clear access and may be useful or necessary for particular procedures or assisted births.
But it is only one possible position.
A 2025 network meta-analysis examining 25 randomized controlled trials involving 9,844 first-time mothers compared eight categories of birth positions.
For the specific outcome of second-stage duration, upright and free-position approaches performed better than lithotomy in that analysis.
That does not establish that lithotomy is universally unsafe or inappropriate.
The 2025 review focused principally on how long the second stage lasted, not every maternal and neonatal outcome that matters.
The clinical question should therefore not be:
“Is lithotomy bad?”
It should be:
“Is lithotomy necessary or useful in this situation, or is another position also clinically appropriate?”
What Does the Newer 2025 Evidence Add?
The famous Cochrane review behind the 9,015 figure searched the literature up to 2016.
That makes it influential, but not new.
A more recent 2025 systematic review and network meta-analysis examined 25 randomized controlled trials involving 9,844 nulliparous women and compared multiple positions during the second stage of labour.
For reducing second-stage duration, upright positions ranked highest in that analysis, followed by:
free position,
semi-recumbent,
and lateral positions.
Compared with lithotomy, the analysis estimated a reduction of roughly 24 minutes with upright positions.
That sounds much more dramatic than the six-minute Cochrane figure.
But the two numbers should not be treated as contradictory headlines.
The studies used different:
inclusion criteria,
analytical methods,
position classifications,
and populations.
The 2025 study specifically included nulliparous women and focused on second-stage duration as its primary outcome.
Its own authors also concluded that larger multicentre randomized trials are still needed.
This is a good example of why responsible medical content should show the reader the evidence landscape rather than selecting whichever number makes the most dramatic headline.
Does Squatting Make Birth Easier?
It can be a useful position for some women, but the evidence does not support claiming that squatting is universally the best birth position.
Squatting changes pelvic orientation and makes use of an upright posture, but it can also be physically demanding and may not be practical or clinically appropriate for every patient.
In the 2025 network meta-analysis, squatting did not rank above all other positions for reducing the duration of the second stage.
Upright and free-position categories ranked higher in that specific analysis.
That is another reason “best birthing position” articles can be misleading.
There is a substantial difference between:
being allowed to move freely and find a useful position
and
being instructed to squat because the internet says it is optimal.
Can You Give Birth Sitting Up?
Yes.
Sitting and semi-seated positions are commonly included among the positions studied during childbirth.
But there is a large range between sitting almost vertically and being slightly elevated in bed.
The angle matters.
Support matters.
The woman's mobility matters.
The birth bed or surface being used also matters.
Therefore “sitting position” in one study may not be physically identical to “sitting” in another.
That inconsistency is one of the methodological problems researchers face when comparing birth-position trials.
Can You Give Birth on Your Side?
Yes.
A lateral or side-lying position is an important option, particularly because it should not be confused with lying flat on the back.
For women with epidural analgesia, evidence is especially interesting.
The large BUMPES randomized controlled trial involved 3,093 first-time mothers with low-dose epidural analgesia.
Women allocated to a lying-down strategy had a higher rate of spontaneous vaginal birth than women allocated to an upright strategy:
approximately 41.1% versus 35.2%.
Importantly, “lying down” in that evidence did not mean forcing women flat on their backs.
The later Cochrane review described appropriate recumbent approaches as lying on the left or right side rather than flat supine or with the legs raised in stirrups.
This finding is one of the clearest reasons that epidural and non-epidural births should not be mixed together in simplistic online advice.
Does an Epidural Change the Best Birth Position?
Potentially, yes.
And this may be the most important qualification in the entire article.
The 9,015-woman Cochrane review behind our headline included women without epidural anaesthesia.
A separate Cochrane review looked specifically at women with epidurals and included eight studies involving 4,464 women and babies.
Across all studies, there was no clear overall difference between upright and recumbent positions for Caesarean or instrumental birth.
But in the higher-quality trials, lying-down positions appeared to produce better operative-birth outcomes than upright positioning.
Modern low-dose epidurals may still allow considerable mobility, and WHO continues to recommend supporting a woman's choice of birth position, including upright positions, with epidural analgesia where feasible.
So epidural does not automatically mean:
“You must stay in bed.”
But it can change:
mobility,
balance,
monitoring requirements,
and the evidence around particular positions.
Is Lying Flat on the Back Dangerous During Labour?
“Dangerous” is too broad.
But lying completely flat on the back deserves special consideration.
NICE advises that during the second stage of labour, lying flat on the back can result in lower maternal blood pressure and may reduce placental blood flow.
This relates partly to the weight of the pregnant uterus affecting major blood vessels.
That does not mean every semi-reclined or recumbent birth is unsafe.
Again:
supine, semi-recumbent and lateral positions are not identical.
Side-lying, for example, is specifically recognized as an option in modern guidance.
Does an Upright Position Reduce the Chance of a C-Section?
The evidence does not justify making that claim for the second stage of labour.
In the 9,015-woman Cochrane review of women without epidural, there was no clear difference in Caesarean-section rates between upright and supine groups.
During the first stage of labour, the evidence landscape is somewhat different.
ACOG cites evidence suggesting that upright positioning and ambulation during the first stage may shorten labour and may be associated with lower Caesarean rates, although other reviews have found less clear differences.
ACOG therefore supports frequent position changes for comfort and fetal positioning when they remain compatible with appropriate maternal and fetal monitoring and treatment.
That distinction matters:
first stage is not the same as second stage.
A blog that talks about “labour position” without specifying the stage may accidentally mix fundamentally different questions.
Does Birth Position Affect Forceps or Vacuum Delivery?
Potentially.
Among women without epidural in the Cochrane review, upright birth positions were associated with fewer assisted vaginal deliveries.
The relative risk was approximately 0.75, based on 21 trials and 6,481 women, with the evidence rated moderate quality.
That is one of the stronger findings in the review.
But it still does not mean upright positioning prevents forceps or vacuum delivery in an individual birth.
Assisted vaginal birth can become necessary for many reasons unrelated to maternal position.
Does Birth Position Affect Episiotomy or Tearing?
Possibly — and this is where trade-offs appear.
In women without epidural, upright positions in the Cochrane review were associated with fewer episiotomies.
At the same time, there was a possible increase in second-degree perineal tears.
There was no clear difference in severe third- or fourth-degree tears, although the evidence for severe tears was very uncertain.
This is a perfect example of why:
“position X reduces tearing”
is too simplistic.
Different forms of perineal trauma need to be separated.
Episiotomy is not the same outcome as spontaneous second-degree tearing.
And neither is the same as a severe third- or fourth-degree tear.
Does Upright Birth Increase Blood Loss?
The 9,015-woman review found more cases of estimated blood loss of 500 mL or greater in upright positions.
The relative risk was approximately 1.48, and evidence was rated moderate quality.
However, the review's authors also noted that this could partly reflect differences in blood-loss measurement.
That is an important caveat.
Researchers have to distinguish between:
more bleeding actually occurring,
and
blood loss simply being measured differently or more accurately.
Therefore this result deserves attention but should not be converted into:
“Upright birth causes postpartum haemorrhage.”
The evidence does not support that simplistic statement.
Why Might Birth Position Matter at All?
There are several plausible mechanisms.
Position changes alter:
the orientation of the pelvis,
maternal body mechanics,
gravity,
pressure distribution,
and how the uterus relates to major maternal blood vessels.
The relationship between the fetus and the pelvic axis may also change.
Different positions may additionally affect maternal comfort and the ability to move or respond to contractions.
Cochrane notes that upright positions may allow the pelvis to expand as the baby descends and may take advantage of gravity.
But clinical outcomes remain more complicated than biomechanics alone.
This distinction matters.
A mechanical explanation that makes intuitive sense does not automatically prove better clinical outcomes.
Biomechanical plausibility is not the same as a randomized trial.
Why Do So Many Hospital Births Still Happen Lying Down?
There is probably no single reason.
Birth position can be influenced by:
the woman's preference,
the setting,
epidural analgesia,
fetal and maternal monitoring,
clinical intervention,
caregiver preference,
the need for procedures,
room layout,
and the patient-support equipment available.
Cochrane explicitly notes that birth position can be shaped by:
setting,
maternal choice,
caregiver preference,
and medical intervention.
This makes the issue more complicated than:
“Hospitals make women lie down.”
Sometimes a particular position may be required clinically.
Sometimes it may simply be familiar.
Sometimes the woman prefers it.
Sometimes the equipment makes one position much easier than another.
The more useful question is whether the environment:
allows flexibility when flexibility is clinically appropriate.
What Does WHO Recommend About Birth Position?
WHO takes a choice-oriented approach.
Its current implementation guidance recommends encouraging mobility and upright positioning during labour for low-risk women.
For the actual birth, WHO recommends supporting the individual's choice of position — including upright positions — whether or not epidural analgesia is being used.
WHO also explicitly states that:
a particular position should not be forced.
Women should be supported in adopting the position they find most comfortable.
WHO simultaneously acknowledges uncertainty.
For women without epidural, upright positions may reduce episiotomy and instrumental vaginal birth but may increase postpartum blood loss and second-degree tears.
Most of the evidence is of low certainty.
That is a much more nuanced position than the typical internet answer.
What Does NICE Recommend?
The UK's NICE guidance also focuses on avoiding a one-position-fits-all approach.
For women without epidural in the second stage, NICE advises avoiding lying flat on the back and says women can use other comfortable positions.
Upright positions and mobility may offer benefits, including possible reductions in fetal heart-rate abnormalities and episiotomy and improvements in birth experience.
For women with epidural, NICE again advises against lying flat on the back and notes that side-lying may improve the chance of spontaneous vaginal birth, while other comfortable positions — including upright positions — can also be used.
So both NICE and WHO converge on an important idea:
position choice matters, but context matters too.
What Does ACOG Recommend?
ACOG's labour-management guidance supports frequent position changes during labour to improve comfort and potentially promote optimal fetal positioning, as long as the position remains compatible with necessary maternal and fetal monitoring and treatment.
This qualification is important.
Clinical flexibility is not the same thing as unrestricted movement in every possible situation.
Fetal monitoring,
maternal instability,
anaesthesia,
urgent intervention,
or another clinical issue
can change what positions are safe or practical.
Modern intrapartum care is therefore less about prescribing one posture and more about maintaining options:
until there is a reason to narrow them.
Is There One Position Every Woman Should Avoid?
There is no universal “never use this position” rule that applies to every clinical situation.
However, prolonged flat-on-the-back positioning deserves particular attention because modern guidance notes potential effects on maternal blood pressure and placental blood flow.
Beyond that, whether a position is appropriate depends on the specific birth.
The safest approach is not an online ranking.
It is individualized clinical assessment.
What About Hands-and-Knees?
Hands-and-knees is generally grouped with kneeling or upright positions in childbirth research.
It may be comfortable for some women and allows a very different pelvic orientation from lying on the back.
But research has not established hands-and-knees as the single best birth position.
The 2025 network meta-analysis compared kneeling with several other position categories and found that relative performance varied depending on the comparison.
Again, the strongest argument is not:
“Everyone should use hands-and-knees.”
It is:
The birth environment should not make hands-and-knees impossible when it is clinically appropriate and desired.
Birth Position and Birth Equipment Are Two Different Questions
This distinction is critical for a medical-equipment manufacturer.
Clinical research does not show that buying a particular delivery bed automatically creates better obstetric outcomes.
A delivery bed cannot determine fetal position.
It cannot determine whether an epidural is required.
It cannot remove the need for an instrumental delivery.
And equipment should never dictate a clinical position that the care team considers inappropriate.
The procurement question is narrower:
Does the physical environment unnecessarily restrict positions that the maternity team would otherwise want to support?
That is where birth-bed design becomes relevant.
Optium's existing guide explains the architectural difference between a dedicated delivery bed and a gynecology table — particularly around patient repositioning, foot-section transformation and the transition from labour to delivery and immediate post-delivery care.
Delivery Bed vs Gynecology Table: What’s the Difference?
The Birth Environment May Matter More Than We Think
A particularly relevant study appeared in 2026.
Researchers in Türkiye compared mobility-enabling labor–birth–postpartum beds with traditional gynecological tables in a maternity unit.
The quasi-experimental study followed 320 vaginal births, with 160 women in each group.
The primary result is important because it prevents us from exaggerating:
The mobility-enabling beds did not significantly shorten total labour duration.
Median labour duration was approximately seven versus nine hours, but the difference was not statistically significant.
After adjustment for multiple comparisons, episiotomy and fundal compression occurred less frequently in the mobility-enabling-bed group, and women reported lower pain scores and higher birth satisfaction.
There were no significant neonatal differences after the study's adjusted significance threshold was applied.
But this was not a randomized controlled trial.
Women were allocated according to room availability, and the research was performed in one maternity unit.
The authors themselves describe the study as quasi-experimental.
Therefore the correct conclusion is not:
“Delivery beds improve birth outcomes.”
It is:
The physical birth environment may interact with mobility, position choice and birth experience, and this deserves better research.
That is far more interesting — and far more defensible.
A Birth Bed Should Support Change, Not One “Perfect” Position
If the evidence tells us anything consistently, it is that childbirth is dynamic.
A woman may prefer one position during contractions.
Another while pushing.
Another after an epidural.
And another if the clinical situation changes.
That means a delivery platform should not be evaluated solely by asking:
“Can it create the lithotomy position?”
A more useful procurement question is:
“How easily can the platform support the range of positions our maternity team actually uses?”
That can include questions about:
backrest movement,
height adjustment,
foot-section transformation,
patient hand grips,
leg and heel supports,
squatting support,
bed conversion,
staff access,
and the speed with which one configuration can change into another.
Optium's maternity portfolio includes electronic delivery beds, a hydraulic birthing bed and gynecology platforms, illustrating that different care models may require different architectures.
Explore Delivery Beds & Gynecology Tables
Why the Foot Section Matters More Than Motor Count
Birth-bed brochures often emphasize motors.
But position flexibility is not simply a motor-count problem.
The foot end can be just as important.
During one episode of care, the same platform may need to behave more like a bed during labour and then create greater pelvic access during delivery.
A sliding, retracting or removable foot section can change the geometry considerably.
This is one of the major distinctions explained in Optium's delivery-bed-versus-gynecology-table guide.
Read the Delivery Bed vs Gynecology Table Guide
That is also why a gynecology table with more motors is not automatically a more flexible birthing platform than a purpose-designed delivery bed with fewer motors.
Positioning functions and workflow architecture are different things.
How OBSTETRA Supports Positioning Flexibility
Optium's OBSTETRA is a transformable electronic delivery bed using powered column motors.
Its current specification includes powered:
backrest,
legrest,
height,
Trendelenburg,
and reverse Trendelenburg adjustments,
along with a sliding foot section.
It also includes:
patient hand grips,
adjustable leg supports,
heel supports,
and a squatting bar.
The platform can convert back into a bed configuration.
Those specifications should not be interpreted as evidence that OBSTETRA improves a particular obstetric outcome.
They describe what the equipment can physically support.
That is the appropriate relationship between clinical evidence and product information.
View the OBSTETRA Electronic Delivery Bed
What About a Different Delivery-Bed Architecture?
Not every maternity department needs the same configuration.
The DB 34 uses three motors and a scissor architecture rather than the column-motor architecture of OBSTETRA.
Its current specification includes:
powered backrest,
powered height adjustment,
Trendelenburg,
reverse Trendelenburg,
a sliding foot section,
adjustable patient hand grips,
adjustable leg supports,
and conversion to bed mode.
That difference matters for procurement.
A hospital should not begin by asking:
“Which Optium delivery bed is best?”
It should first ask:
“Which positioning and workflow capabilities does this maternity unit actually require?”
View the DB 34 Electronic Delivery Bed
Delivery Bed or Gynecology Table?
Position-choice evidence makes this distinction even more relevant.
A gynecology table can offer excellent clinician access and sophisticated positioning.
For example, Optium's GYNEA 3 provides:
powered backrest,
height,
Trendelenburg,
reverse Trendelenburg,
adjustable leg supports,
and a removable fluid basin.
But a delivery bed is designed around a broader changing workflow.
That can include:
labour,
repositioning,
delivery,
immediate post-delivery care,
and conversion back toward a bed configuration.
The difference is therefore not:
“Can both platforms move?”
It is:
“What sequence of movements and care does the patient need the platform to support?”
For the full technical comparison:
Delivery Bed vs Gynecology Table
What Should Hospitals Ask When Designing a Position-Friendly Maternity Room?
The birth bed is only one part of the environment.
A hospital planning a maternity room should ask:
Is there enough space for staff to access different sides of the patient?
Can monitoring continue as the patient changes position?
How does the foot section operate?
Where do removable accessories go?
Can the patient enter and leave the bed safely?
Is emergency access maintained in different configurations?
The hospital should also involve the people who actually use the room:
midwives,
obstetricians,
anaesthesia teams,
nurses,
biomedical engineers,
cleaning staff,
and where possible, patient-experience teams.
The goal should not be to create a room optimized for a trendy birth position.
It should be to create a room capable of adapting to the clinical reality of childbirth.
Frequently Asked Questions About Birth Positions
What is the best position to give birth?
There is no single best position for every woman.
Current WHO guidance supports allowing the woman to use a comfortable position, including upright positions, when clinically appropriate.
The evidence differs depending on whether epidural analgesia is being used.
Is standing better than lying down during labour?
Not universally.
Upright movement during labour can offer benefits for some women, but clinical conditions, comfort, monitoring and epidural use matter.
Is squatting the best position for childbirth?
No single position has been proven best for everyone.
Squatting is one possible upright position, but recent comparative research does not show that it universally outperforms all other positions.
Is it bad to give birth lying on your back?
Lying completely flat on the back can lower maternal blood pressure and may reduce placental blood flow.
But recumbent positions differ.
Side-lying, for example, is not the same as flat supine positioning and may be useful, particularly with epidural analgesia.
Can you give birth on your side?
Yes.
Side-lying is an established childbirth position.
Evidence involving women with epidurals suggests that appropriate lying-down positions, particularly lateral positions rather than flat supine, may sometimes improve the chance of spontaneous vaginal birth.
Can you give birth sitting up?
Yes.
Sitting and semi-seated positions are included in childbirth research and can be used when clinically appropriate.
Can you give birth on hands and knees?
Yes.
Hands-and-knees is generally included among kneeling or upright birth positions and may be comfortable for some women, although evidence does not identify it as universally superior.
Does giving birth upright make labour faster?
Possibly, but the size of the effect is uncertain.
The older Cochrane review found an average reduction of around six minutes in the second stage among women without epidural, while a 2025 network meta-analysis found larger differences in some comparisons.
Both bodies of evidence have limitations.
Does giving birth upright reduce forceps or vacuum delivery?
In the Cochrane review of women without epidural, upright positions were associated with fewer assisted vaginal births.
This does not mean position alone determines whether an assisted delivery will be needed.
Does birth position reduce C-section risk?
Evidence from the second stage does not show a clear reduction in Caesarean sections from upright positioning alone.
Position and mobility during the first stage have a different evidence base and should not be confused with second-stage birth-position studies.
Can women with an epidural change birth position?
Often, yes, particularly with modern low-dose epidural techniques.
But mobility and safe positioning depend on:
the degree of motor block,
monitoring requirements,
and individual clinical circumstances.
What is lithotomy position in childbirth?
Lithotomy generally refers to a recumbent position in which the legs are elevated and supported, commonly used when clear clinical access is required.
It is one of several possible positions rather than a universal requirement.
Why do hospitals use delivery beds?
A delivery bed is designed to support a changing maternity workflow and may combine:
labour positioning,
delivery access,
a transformable foot section,
patient-support accessories,
mobility,
and post-delivery bed use.
It is different from a gynecology table, which is generally more focused on examination and procedural access.
So What Do 9,015 Births Really Tell Us?
Not that women should stand.
Not that they should squat.
And not that they should never lie down.
The most responsible reading of the evidence is more subtle.
Among women without epidural, upright positions may offer several benefits, particularly:
fewer assisted births,
and fewer episiotomies,
while introducing potential trade-offs and uncertainty.
With epidural analgesia, the evidence changes, and appropriate side-lying positions may sometimes perform better than an upright strategy.
Newer research continues to suggest that position can influence labour, but even recent meta-analyses conclude that stronger trials are needed.
WHO's approach captures the evidence particularly well:
Support choice. Avoid unnecessarily forcing one position. Adapt to the clinical situation.
And that leads to an equally important design principle for maternity care:
A birth environment does not need to decide the position in advance.
It needs to be capable of changing when the patient and clinical team need it to.
What This Means for Maternity Equipment Planning
For hospitals, the birth-position discussion should not be converted into:
“Buy an upright birthing bed.”
That would misunderstand both the evidence and the role of medical equipment.
Instead, procurement teams can ask whether their maternity platform supports the positions their clinical team actually uses, whether it can change configuration efficiently, whether staff access remains adequate and whether the same platform can support the changing workflow before, during and immediately after birth.
Optium's Delivery Beds & Gynecology Tables range includes multiple platform architectures rather than presenting one configuration as universally correct.
Explore Optium Delivery Beds & Gynecology Tables
That is ultimately the more useful lesson from thousands of births:
The goal is not to design around one “perfect” position.
The goal is to avoid making an appropriate position unnecessarily difficult.
Methodology and Sources
The central “9,015 births” figure in this article comes from the Cochrane systematic review Position in the second stage of labour for women without epidural anaesthesia.
Thirty randomized trials involving 9,015 women contributed data to the review.
Because that evidence was collected through 2016, this article also reviewed a 2025 systematic review and network meta-analysis of 25 randomized controlled trials involving 9,844 nulliparous women.
That analysis focused primarily on second-stage duration and compared eight categories of childbirth position.
Evidence concerning women using epidural analgesia was evaluated separately using the updated Cochrane review of eight studies and 4,464 participants, together with the BUMPES randomized controlled trial involving 3,093 first-time mothers.
Current guidance was reviewed from the World Health Organization, NICE and the American College of Obstetricians and Gynecologists.
WHO supports maternal mobility and birth-position choice, including upright positions, while emphasizing that no position should be forced.
NICE differentiates flat supine positioning from lateral and other comfortable positions.
ACOG supports position changes when compatible with necessary monitoring and clinical treatment.
The maternity-equipment section also references a 2026 quasi-experimental study of 320 vaginal births comparing mobility-enabling labor–birth–postpartum beds with traditional gynecological tables.
Because participants were not randomly assigned and the study was conducted in a single maternity unit, its findings are presented as observational evidence about the broader care environment rather than proof that a specific bed design causes better clinical outcomes.
Medical note: This article provides general educational information and is not medical advice. Birth position should be determined according to maternal preference, clinical circumstances, fetal and maternal condition, anaesthesia, local protocols and the judgment of qualified maternity professionals.