Even before you begin labour your infant has begun positioning themselves ready for delivery. During labour your little one is moving through what is called the 7 cardinal movements of labour. These are positions they move through to be able to exit the pelvis. By learning about how babies enter the world, you can prepare yourself in different positions during labour to assist.

Cardinal movements:

1 &2 Engagement/Descent

These 2 phases can happen days or weeks before labour even begins. In this phase your little one is moving down towards the pelvic outlet. They should be head down and their spine should be facing away from your spine. In the week leading up to your delivery try to avoid slouching on the couch or spending prolonged times on your back to avoid baby’s spine facing your spine.

  1. Flexion

During the second phase of labour, your baby has moved further into the pelvis. As they descend, their heads will be transverse. This means that their bodies and heads will be facing the side of the pelvis. To be delivered vaginally baby needs to find a way to face your spine. They do this by tucking their chin to their chest to be able to turn and accommodate for the shape of your sacrum.

  1. Internal Rotation

This next stage your baby is turning their head to look towards your spine. By turning their head, the shoulders and body turns and aligns their body to face your spine and the back of their head faces your pubic bone.  This movement continues to assist the position of bub so the smallest part of their head may be delivered first.

  1. Extension

In this position baby’s head has moved to the entrance of the vagina. Your baby’s head must move underneath your pubic bone as it exits the pelvis.

  1. External Rotation

In this position the head and shoulders are delivered. Your bub will turn their head to the side causing the shoulders to be delivered at the same time.

  1. Expulsion

Here is where your baby is fully delivered and exits the pelvis.

How can positions help change your second phase of labour experience?

Time spent in the second stage;

An article by Huang, J et al investigated how maternal positions can affect the second stage of labour and position baby best. A recent study found that:

  • Upright positions such as sitting, squatting or kneeling can reduce the duration of second stage of labour by 6.6minutes compared with delivering on your back (Gupta et al 2017).
  • Squatting reduced the second stage of labour by 9minutes in both primiparous and multiparous women compared to delivering on your back. (Dani, A et al 2015). B

Upright position during the second phase of labour research suggests that it increases the size of the pelvic diameter thereby enabling faster progress. (Gupta,J et al 2017)

Reduce Perineal Trauma;

  • Upright or side lie positions are best for reducing the risk of perineal trauma. (Gupta, J et al 2017).
  • In women with more than 1 child, squatting can increase the risk of obstetric anal sphincter injuries (OASIS) compared with women in a recumbent position in bed or water births. (Elvander et al)
  • 4-point kneeling can increase movement available to mum and has the lowest risk of OASIS

Promoting fetal and newborn wellbeing;

  • Upright and lateral positions had fewer abnormal fetal heart rate patterns (Gupta, J et al 2017)

By booking in for a prenatal education session with the physiotherapists at Bump Fitness we can go through different labour positions as well as good pushing strategies. This may help decrease the risk of pelvic floor or perineal trauma because of vaginal deliveries. Reach out today to best prepare yourself for welcoming your new arrival.



  1. Gupta J.K., Sood A., Hofmeyr G.J., Vogel J.P. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2017;5:CD002006.  Position in the second stage of labour for women without epidural anaesthesia – PubMed (nih.gov)
  3. Huang J, Zang Y, Ren LH, Li FJ, Lu H. A review and comparison of common maternal positions during the second-stage of labor. Int J Nurs Sci. 2019 Jun 20;6(4):460-467. doi: 10.1016/j.ijnss.2019.06.007. PMID: 31728401; PMCID: PMC6839002. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839002/