Not Just on Your Back: OT + Doula-Approved Birth Positions
May 2025
Let’s talk about birth. Real birth, not the flat-on-your-back, feet-in-stirrups, yelling-at-your-partner kind you see on TV. That position? It’s actually one of the least effective ways for letting your baby make their grand entrance. Your pelvis isn’t just a bowl holding everything in, it’s dynamic, it’s responsive, and it wants to move.
As a pelvic floor occupational therapist and a doula, I’ve got some good news: you’ve got options for birth positions. Lots of them. And yes, even if you have an epidural.
Read Not Just On Your Back: OT + Doula-Approved Birth Positions to discover 5 birth positions that can help your baby descend, reduce tearing, ease pain, and let you feel more in control of your birth experience.
Here are a few of my favorite birth positions that are both OT-approved and doula-beloved:
🌙 Side-Lying (The Cozy Queen)
The side-lying birth position is perfect for epidurals, exhaustion, or if you just need a little rest while still making progress. Lie on your side with a peanut ball or pillows between your knees—this opens up the pelvis and reduces pressure on the perineum. Having a partner stabilize the peanut ball can also be very helpful!
🐸 Supported Squat (Channel Your Inner Forest Creature)
The supported squat birth position is primal in the best way. Use a squat bar, your partner, or even hang onto a rebozo for support. Squatting opens the pelvis by up to 30% (yep, really!) and helps baby move down with gravity.
🙃 Hands and Knees (A Doula Classic)
This birth position is my go-to for back labor or a baby that’s sunny-side up. It takes pressure off the low back and can help reposition baby. Also a great position to breathe deeply and connect to your pelvic floor without a ton of strain.
🕺 Standing Lunge or Hip Sway
Put one foot on a step or stool, lean in, and sway it out. This can also be done from a kneeling position, if that feels more comfortable to you. This birth position is great for encouraging rotation and descent, especially if baby needs a little directional help. Feels weirdly empowering—like birth meets a dance party in your pelvis.
🚽 The Toilet or Birth Stool (A.K.A. The Throne)
One of my favorite places for birthing folks to labor! Let’s not overlook the humble toilet. It naturally cues pelvic floor relaxation (thank you, nervous system!) and is a great way to labor or push without extra pressure. Also ideal for privacy and those “I just need a minute” moments.
Bonus: make the bathroom like a fairy wonderland with twinkly lights and good smells. This can act as a birthing cave to support you and your nervous system.
But Wait—What If I Have an Epidural?
You still have options for birth positions if you have an epidural! Even with limited mobility, you can do supported side-lying, semi-reclined pushing, and even some modified hands-and-knees or assisted squatting if you’ve got a strong team around you. Don’t let the epidural box you in.
Final Thoughts
Birth doesn’t have to look just one way. It doesn’t have to be flat, passive, or overly clinical. Your body knows how to move, and with the right tools and support, you can find the position that feels most aligned.
Whether you’re planning an unmedicated home birth or prepping for a hospital epidural, you’ve got choices for birth positions. Your pelvis is magical, your breath is powerful, and your body deserves to be supported every step (and squat) of the way.
Need help preparing?
That’s my jam! Supporting birthing folks has been one of my greatest joys.
Let’s get you ready to meet your baby your way.