5 Tips For Pushing Off Your Back

How to ACTUALLY advocate for upright birth

I’ve seen this happen so many times - a woman is beginning to push when a nurse asks to check her cervix to confirm she’s fully dilated. Since she’s already lying on her back for the exam, it becomes easier to just stay there when pushing begins. And while the answer is rarely a direct “no” when we ask to change positions, there’s often gentle discouragement—something like, “Let’s try this first, then we can move later.” But later doesn’t always come. If you want to avoid being stuck in a position that works against gravity and your instincts, this guide is for you.

Why Pushing Off Your Back Matters
Research shows that supine (lying flat) or semi-reclined positions can compress major blood vessels, reducing oxygen flow to the baby. Upright positions allow for better circulation and oxygenation.

1. More Efficient Pushing
   Gravity can assist when pushing in upright positions like squatting, hands-and-knees, or side-lying, reducing the need for excessive force and prolonged pushing. Studies suggest these positions can shorten the second stage of labor.

2. Lower Risk of Perineal Trauma
   Lying on your back increases perineal pressure, leading to a higher risk of tearing or the need for an episiotomy. Upright positions help the perineum stretch more gradually.

3. Reduced Need for Assisted Deliveries
   Research indicates that pushing on your back increases the likelihood of forceps or vacuum-assisted births, which can contribute to more significant postpartum recovery challenges.

4. Increased Comfort and Autonomy
   Many birthing people report feeling more in control and experiencing less pain when they can move freely and choose a position that feels best for their bodies.

5 Tips for Advocating for Pushing Off Your Back

1. Discuss Your Preferences Early
   Talk with your provider about your birth preferences well before labor. Ask your provider how they usually deliver babies. If they say something like, “I go wherever mom is already,” that’s a green flag. This response suggests they are flexible and supportive of different birth positions. However, if their answer is more along the lines of, “I deliver with mom on the bed just in case baby slips,” or “We prefer moms on their back for better access,” this could indicate a provider who is less open to alternative positions. In this case, follow up with more questions: “Are you comfortable with hands-and-knees or side-lying deliveries? How often do you catch babies in these positions? “ If they seem resistant or hesitant, it may be worth considering a provider who better aligns with your birth goals.

1. Include It in Your Birth Plan
   Clearly state in your birth plan that you want freedom to move and push in the position that feels best. Bring this up in your prenatal appointments, reminding your provider that it is important to you that you can follow your bodies lead to push in various positions, and you hope for their support in that. Make sure your nurse, partner and doula know you do not want direction in pushing, so they can speak up for you when you can't. 

2. Lean on Your Birth Team for Support
   Your doula, partner, or other support person can help remind staff of your preferences when the time comes. They can encourage position changes if they notice you are defaulting to one, and assist you in moving frequently if you have an epidural. 

3. Use Hospital-Friendly Alternatives
   If you have an epidural, pushing on your side or in a supported upright position (such as with a squat bar) can still provide many of the benefits of being off your back. Ask your nurse for a squat bar early on, and make them aware that being able to move is important to you!
   Epidurals only mean you need more help moving, not that you are immobile. 

4. Trust Your Body
   if you feel the instinct to move or shift positions during pushing, listen to that! You have the right to ask for position changes, even if staff encourage a traditional lying-down approach. Advocate for yourself by saying, “I need to change positions” or “This isn’t working for me.”

Breaking the ‘One-Size-Fits-All’ Approach to Pushing

Going into the hospital without a birth plan does not mean you don’t have one, it just means you plan to follow the hospitals. Understanding the benefits of alternative positions and advocating for your right to move can make a significant difference in your birth experience. With preparation, support, and confidence in your body, you can create an environment that allows for a more empowered and instinctive birth.

Ready to get more support in your birth? Contact me for a free consultation to discuss your goals!