You planned to get an epidural. Maybe you pictured yourself finally relaxing, taking a breath, and letting your body do its thing. But then you get to the hospital, the epidural is working, and suddenly someone asks, “What position would you like to try?”
Wait. What? I thought I was supposed to lie in bed!
Here’s something I want every pregnant mom to understand: getting an epidural does not automatically mean you have to give birth lying flat on your back.
There are several positions you can explore with an epidural in place, depending on your level of sensation, leg strength, medical circumstances, and your birth team's recommendations. Some positions may help you feel more comfortable, provide room for your baby to rotate and descend, or give your care team better access for monitoring.
As a pelvic floor physical therapist who loves all things birth biomechanics, I have four favorite epidural-compatible positions I want you to know about: semi-reclined, throne position, side-lying with a peanut ball (also known as the Birth Goddess position), and all fours.
But here's the thing: my favorite position might not be your favorite position. And that's completely okay.
Let's talk about how these positions work, why sacrum mobility matters, and how practicing them during birth prep can help you feel more confident when the big day arrives.
Can You Change Positions With an Epidural?
Yes! In many cases, you can change positions with an epidural, although the options available to you depend on your individual circumstances.
An epidural reduces pain sensation, and it can also affect your leg strength, sensation, and ability to balance. Some people can move their legs quite well with a low-dose epidural, while others have significantly less movement. Your nurse should assess your strength and sensation before helping you try different positions.
Current guidance from the National Institute for Health and Care Excellence (NICE) recommends supporting women with epidurals to use comfortable positions, including upright positions, while avoiding lying completely flat on the back. During the pushing stage, NICE also notes that lying on your side may increase the chance of a spontaneous vaginal birth compared with upright positions in some women.
You can read the recommendations here: NICE guidelines on care during labor and birth.
The goal isn't to find one magical position that guarantees an easier birth. It's to have options.
Your baby's position, your pelvic anatomy, your level of fatigue, the stage of labor, your epidural, and your baby's heart rate can all influence which position works best at a particular moment.
And yes, you may need to change positions throughout labor. That's normal!
1. Semi-Reclined: Comfortable, but NOT Flat
Let's start with a familiar option.
Semi-reclined is often the position people picture when they think about giving birth in a hospital bed. You're leaning back against the elevated head of the bed, with support behind your back and potentially under your knees.
But there's an important distinction: semi-reclined does not mean lying flat on your back.
How to try semi-reclined
Ask your nurse to elevate the head of the bed and help you find a supported position. Depending on your comfort and clinical needs, you might have pillows behind your upper back, your knees supported, or your legs positioned comfortably with assistance.
You can experiment with how upright you feel, rather than assuming you need to be nearly horizontal.
Why you might like it
Semi-reclined can be a good starting point if you want to rest, feel supported, or conserve energy between contractions. It can also be easier to maintain if your epidural makes moving around more challenging.
For some moms, this position feels secure and familiar. And sometimes, especially after a long labor, familiar and comfortable is exactly what you need.
What about your pelvis and pelvic floor?
Your trunk angle and hip position influence how your pelvis is oriented, but there isn't one universally ideal angle for every birth.
A more upright, supported position may feel very different from a nearly flat position. The important thing is to avoid remaining completely flat on your back when possible and to keep reassessing your comfort and clinical needs.
Lying flat can allow the uterus to compress major blood vessels, potentially lowering maternal blood pressure and reducing blood flow to the placenta. This concern is particularly relevant when an epidural also contributes to a drop in blood pressure.
My takeaway: Semi-reclined can be a useful position, especially for rest, but don't assume it's your only option just because you have an epidural.
2. Throne Position: More Upright in the Bed
If semi-reclined feels good but you want to experiment with sitting more upright, meet the throne position.
Think of it as sitting up in the hospital bed with your back supported, rather than reclining far backward.
How to try the throne position
With your nurse's help, raise the head of the bed and adjust the bed into a supported sitting position. Depending on the equipment available, your knees may be bent, your legs supported, and the foot of the bed adjusted to create a comfortable shape.
You want to feel stable, supported, and able to relax your shoulders and jaw.
If your legs feel heavy or numb, don't attempt to reposition yourself without help.
Why you might like it
The throne position can be a nice middle ground between lying down and getting into a more involved position.
You may like it if you want to feel upright but don't feel comfortable being on your hands and knees or lying on your side. It can also be an option for changing positions without requiring as much active movement from you.
Some moms appreciate being able to see their support person, feel more engaged with what's happening, and rest between contractions.
Does sitting upright help the baby descend?
It can change your relationship with gravity and the orientation of your pelvis, but we cannot promise that a throne position will speed up labor or make pushing more effective.
Research on maternal positioning is complicated because studies use different position definitions, and labor progress depends on many factors beyond maternal posture.
The American College of Obstetricians and Gynecologists (ACOG) supports individualized positioning and position changes during labor when they are appropriate for the mother's and baby's clinical circumstances.
Read more in ACOG's guidance on approaches to limit intervention during labor and birth.
My takeaway: The throne position is worth trying if you want a more upright option without having to leave the bed. Just remember that upright doesn't automatically mean better for every mom at every stage of labor.
3. Side-Lying With a Peanut Ball: The Birth Goddess Position
This is one of my favorite positions to teach because it can offer a supported way to position your hips while allowing your body to rest.
Side-lying with a peanut ball is sometimes called the Birth Goddess position. A peanut ball is shaped like a peanut, with a narrower middle and rounded ends, making it easier to position between your thighs or legs while you're lying on your side.
How to try the Birth Goddess position
With help from your nurse, roll onto your side and place the peanut ball between your thighs and legs. Your upper leg can rest over the ball, with your hips and knees comfortably bent.
The exact amount of hip flexion, leg separation, and rotation should be adjusted to your comfort and clinical needs. You don't need to force your knees apart or pull your top leg into an extreme position.
Your nurse can help support your upper leg, adjust the ball, and make sure you are positioned safely.
You can also switch sides during labor if that is appropriate for your situation.
Why you might like it
Side-lying offers support without requiring you to hold yourself upright. It can be especially helpful if you're tired, have a heavy epidural, or simply don't want to do a lot of moving.
The peanut ball provides a way to maintain space between your legs while your body is supported by the bed.
Research on peanut balls has explored whether their use during labor with an epidural affects labor duration and birth outcomes. Results across studies are not uniform, so it's best to think of the ball as a positioning tool rather than a guaranteed way to shorten labor or prevent a cesarean.
Let's talk about your sacrum
This is one reason I love having side-lying in your birth-prep toolbox.
Your sacrum is the triangular bone at the base of your spine that forms the back of your pelvis. During birth, the sacrum and surrounding joints need to accommodate changes in pelvic shape and movement.
In a side-lying position, your sacrum is generally not pressed directly against the bed in the same way it may be when you're lying on your back. This is what we mean when we talk about having a free sacrum.
That does not mean your sacrum is guaranteed to move more or that this position automatically creates more room for your baby. It means the back of your pelvis has less direct external pressure from the bed, which may allow movement that a flat-on-your-back position restricts.
My takeaway: Side-lying with a peanut ball is a great position to practice because it combines support, rest, and options for hip positioning. You don't have to be upright and active for your positioning to matter.
4. All Fours: My Favorite Epidural-Safe Position
If you know me, you probably knew this one was coming.
All fours is my favorite position on this list because it gives you a completely different relationship with gravity, your hips, and your sacrum compared with lying on your back.
And no, you don't have to have an unmedicated birth to explore it.
How to try all fours with an epidural
With adequate leg strength and sensation, assistance from your care team, and approval based on your clinical circumstances, you may be able to position yourself on your hands and knees on the hospital bed.
Your nurse may help you roll onto your side first, then move into the position with appropriate support. Pillows can be used for comfort, and the bed can be adjusted to help you feel stable.
If you don't have enough strength or sensation to support yourself safely, your team may recommend a modified alternative, such as leaning forward over an elevated bed or using another supported position.
You should never attempt hands and knees independently if your epidural affects your ability to balance or bear weight safely.
Why I love all fours
First, it gives your abdomen room rather than pressing it into the bed.
Second, it changes how your hips and pelvis are oriented. You can make small movements, such as gently rocking your pelvis forward and backward or shifting your weight from side to side, if those movements feel comfortable and your team says they are appropriate.
Third, it allows your sacrum to remain relatively free from direct pressure against the bed.
Remember, the sacrum is part of the back of your pelvic ring. When you're lying flat on your back, the bed applies pressure to this area. In all fours, that direct pressure is reduced, allowing a different opportunity for sacral movement.
This doesn't mean that your pelvis automatically opens more in every direction. Pelvic mechanics are more nuanced than that, and the baby's position and the stage of labor matter.
But having options for how you orient your pelvis is valuable.
Can all fours help with back labor?
Some women find hands and knees or other forward-leaning positions more comfortable when experiencing back labor. The position may also allow the support person or care team to apply counterpressure to the lower back if appropriate.
However, there is not strong evidence that all fours will rotate every baby who is facing upward, eliminate back labor, or prevent assisted delivery.
It is an option to try, not a promise of a particular outcome.
Can you push in all fours with an epidural?
Sometimes. Whether this is possible depends on your strength, sensation, monitoring needs, and your care team's assessment.
Some hospitals may be more comfortable supporting this position than others. Ask about it before labor so you understand what your birth location can accommodate.
My takeaway: All fours is my favorite because it gives you another way to move and position your pelvis while keeping the sacrum relatively free. But it is only a good option if you can maintain it safely with your epidural.
