From Active Birth by Janet Balaskas and Empowering Women by Andrea Robertson; Compiled by Andrea Eastman, MA, CCE, IBCLC for The Gentle Birth Alternatives® Website

Active Birth: This term was originally used by Janet Balaskas, who utilized it to counter the medical term "active management of labor". Active birth has become a philosophic approach to birth. It is a convenient way of describing normal labor and birth and the way that a woman behaves when she is following her own instincts and the physiological logic of her own body; when she is doing what feels right. (Robertson,1994)

"An active birth is instinctive. It involves giving birth quite naturally and spontaneously through your own will and determination, having the complete freedom to use your body as you choose and to follow its urges. Active birth is an attitude of mind. It involves acceptance and trust in the natural function and involuntary nature of the birth process, as well as an attitude or appropriate positioning of your body." (Balaskas, 1992.)

The essence of active birth can be summarized as a birth in which...
  • A woman labors instinctively, following her own physiological rhythms and responses.

  • The woman takes responsibility for arranging an appropriate setting and caregivers who will enable her to labor as she needs when the time comes.

  • The woman, and her partner, are involved in all aspects of pregnancy and birth care, and are enabled to make informed decisions whenever necessary.

  • Management of the labor is rooted in the midwifery rather than the medical model.

  • It is assumed by all involved that the labor and birth are normal, until there is conclusive medical evidence of a problem.

  • The woman's assessment of the outcome is accepted and used as the primary measure of success or satisfaction, rather than evaluations made by her caregivers.

  • An active birth could also be described as one in which the woman is empowered to give birth using her own resources and abilities. In simple terms, a person is empowered when they take control over what happens to them. (Robertson, 1994)


  • Gravity assists uterine contractions and bearing-down efforts. When upright, the mother's body is in harmony with the downward pull of gravity. When lying down, her involuntary efforts to expel the baby are inhibited; she must strain harder to push the baby uphill, and she is more likely to require the assistance of forceps or vacuum extraction.

  • Less effort is demanded of the uterus. Since the uterus tilts forward during a contraction, a mother can lean forward and assist her uterus to work without resistance. When she is lying down, her uterus must work harder and less efficiently.

  • It is easier for the baby's head to enter the mother's pelvis when she is upright, and provides the baby with the best angle of descent, in relation to gravity, through the pelvic canal.

  • Placental circulation is improved, giving the baby a better supply of oxygen.

  • The nerves that supply the pelvis and the uterus arise from the lower part of the spinal cord and enter through the sacrum. When there is no direct pressure on the nerves, less pain is felt.

  • As long as the mother is upright, the pelvic joints are free to expand, move, and adjust to the shape of the baby's descending head. The coccyx is designed to swivel backwards to widen the outlet of the pelvis as the baby emerges. This is impossible if the mother is sitting on her tailbone in the classic position for pushing used by many childbirth education methods (also called the sitting squat or semi-reclining).

  • When a mother is upright, her perineal tissues can expand evenly and pull back around the baby's emerging head, significantly decreasing the need for an episiotomy. (Balaskas, 1992)


WALKING OR STANDING: This shortens the labor and increases the efficiency of contractions. In the early part of the first stage, try to walk around, leaning forward for contractions. You may want to use a wall for support, or let yourself hang onto someone as they support most of your weight during contractions.

SQUATTING: This is the most physiologically efficient position for labor and birth. Squatting opens the pelvis, "Your pelvis is at its most open, gravity is helping, and contractions are intensified due to increased pressure from the baby's head on the cervix." (Balaskas, 1992) Remember to rest completely between contractions using a stool, the support of another person, a firm cushion, etc. so that you are not tired out from squatting.

SITTING: Sitting upright, on a chair, a bed, on the floor. The contractions are not as intense as in squatting, but are still aided by gravity. Some women find that sitting on the toilet is most comfortable. It allows a place for the dripping of amniotic fluid, and it leaves the pelvic floor free. In addition, it allows women to relax their pelvic floor more completely because of the association of sitting on the toilet with letting go.

KNEELING: Many women find kneeling the most comfortable in the last part of the first stage, 6 to 10 cm dilation, including transition. This can be dome sitting backward on a chair, on the toilet, a bean bag chair, on a pile of pillows. Some women also use some sort of rocking or rhythmic motion while kneeling. This position is good for posterior babies that are causing their mothers a great deal of back labor. The swiveling of the hips can help encourage the baby to turn.


KNEELING: See above.

KNEE-CHEST: This position is useful for women who are not completely dilated (who have a lip of cervix). This position brings the baby forward and reduces pressure on the cervix. Moving the hips through a contraction will help the woman progress to full dilation within a few contractions.


SUPPORTED SQUATTING: Squatting makes optimum use of gravity, most efficient position for rapid descent of baby. Can use one or two supporters or a chair.

KNEELING OR ALL-FOURS: An ideal position if second stage has been very fast. If baby is posterior, can relieve backache.

SIDE-LYING: This can be useful position for birth because it leaves the sacrum (tailbone) free to move. Since it does not allow for gravity to help, it should not be used if second stage is slow.

assorted labor positions

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