Why the All Fours Position Is One of the Best Labor Positions
The all fours position, also known as the hands-and-knees position, is one of the most versatile and effective positions you can use during labor and delivery. Whether you are dealing with back labor, a slowly progressing first stage, or simply searching for comfort during contractions, getting onto your hands and knees can provide immediate relief and meaningful physiological benefits.
In this position, gravity works with your body rather than against it. Your baby's weight shifts forward and away from your spine, which is why so many women instinctively move to all fours when contractions intensify. Research published in the Journal of Midwifery & Women's Health shows that the hands-and-knees position can increase the pelvic outlet diameter by up to 28%, giving your baby more room to descend and rotate.
Key benefit: The all fours position is one of the only labor positions that simultaneously relieves back pain, encourages optimal fetal positioning, and opens the pelvis wider. It is a foundational position that every expectant parent should practice before labor begins.
When to Use the Hands-and-Knees Position
Back Labor Relief
Back labor occurs when your baby is in a posterior position, with the back of their head pressing against your sacrum. This causes intense lower back pain that often persists between contractions. The all fours position shifts your baby's weight forward and off the spine, providing significant relief. Many women report that back labor pain decreases by 50% or more simply by moving to hands and knees.
Slow Labor Progression
When dilation stalls or contractions lose their rhythm, the all fours position can help restart progress. The combination of gravity and pelvic mobility encourages your baby to descend deeper into the pelvis. Gentle rocking and swaying in this position can also help contractions become more regular and effective.
Optimal Baby Positioning
If your care provider has told you that your baby is posterior or asynclitic (tilted to one side), spending time on all fours during the final weeks of pregnancy and during early labor can encourage rotation. The position creates space for your baby to tuck their chin and turn into the ideal anterior position for delivery.
Variations of the All Fours Position
Cat-Cow Movements
While on hands and knees, alternate between arching your back (cow) and rounding it (cat). This rhythmic movement releases tension in your lower back, mobilizes your pelvis, and encourages your baby to shift into a better position. Many women find the cat-cow rhythm naturally syncs with their breathing during contractions.
Rocking and Swaying
Gently rocking your hips forward and back, or swaying side to side, adds a dynamic element that keeps your pelvis mobile. This movement helps your baby navigate through the birth canal and can make contractions feel more manageable. Try circling your hips in large, slow loops for variety.
Resting All Fours
For longer periods on hands and knees, drape your upper body over a birth ball, a stack of pillows, or the raised head of a hospital bed. This supported version allows you to rest between contractions while maintaining the benefits of the position. You can even close your eyes and use this time to breathe and recharge.
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Partner Support Techniques for All Fours
Your birth partner plays an essential role in making the all fours position comfortable and effective. Here are specific ways a partner can help:
- Counter-pressure: Press firmly on the laboring person's lower back or sacrum during contractions. Use the heel of the hand or a tennis ball for focused pressure.
- Hip squeeze: Place both hands on the sides of the hips and press inward during a contraction. This widens the pelvic outlet and provides significant pain relief.
- Warm compresses: Apply a warm washcloth or heating pad to the lower back between contractions for muscle relaxation.
- Verbal encouragement: Offer calm, steady words of support and help count through contractions when requested.
- Physical stability: If fatigue sets in, a partner can sit in front and offer their thighs or a pillow for the laboring person to rest their head and arms on.
Quick Tips for Success
- Practice the all fours position during the third trimester so it feels natural during labor
- Place extra padding under your knees for comfort on hard hospital floors
- Keep your wrists comfortable by using fists or forearms instead of flat palms
- Combine all fours with other positions — alternate every 20-30 minutes for the best results
Transitioning Between Positions
No single position is perfect for the entirety of labor. The most effective approach is to move between positions regularly, using all fours as a cornerstone. From hands and knees, you can easily transition to a supported squat, a side-lying position, or standing and swaying with your partner. Each transition creates subtle changes in your pelvic shape that help your baby navigate the birth canal.
When transitioning from all fours, move slowly and between contractions whenever possible. Your birth partner or nurse can help stabilize you during position changes. If you feel a strong urge to stay in one position, trust your instincts — your body often knows what it needs.
Important Note
While the all fours position is safe for most laboring women, always communicate with your care provider about your positioning preferences. If you have certain complications or are being continuously monitored, modifications may be needed. Your birth team can help you find comfortable variations that work within your specific care plan.
Frequently Asked Questions
Why is all fours good for labor?
The all fours position uses gravity to help your baby move into an optimal position, takes pressure off your spine to relieve back labor, and opens your pelvic outlet by up to 28%. It gives you freedom to rock and sway during contractions, making them more manageable. Research shows this position can reduce the intensity of back pain and may shorten the pushing stage.
Can the all fours position turn a posterior baby?
Yes, the hands-and-knees position is one of the most effective positions for encouraging a posterior (sunny-side up) baby to rotate to the anterior position. Gravity helps the heaviest part of the baby's head swing forward, naturally encouraging rotation. Spending time in this position regularly in the weeks before labor and during early labor can significantly improve the chances of optimal positioning.
How long should I stay in the all fours position during labor?
There is no strict time limit. Many women find relief staying on all fours for 20 to 30 minutes at a time during active labor, especially during intense contractions. Listen to your body and change positions when you feel fatigued. Using a birth ball or stack of pillows under your upper body can help you stay comfortable for longer periods.
What if I have knee problems — can I still use this position?
Absolutely. If you have knee pain or sensitivity, place extra padding under your knees such as folded blankets or a thick yoga mat. You can also drape yourself over a birth ball or lean on the raised head of a hospital bed to take more weight into your upper body. A kneeling position with upper body support is another comfortable alternative that offers similar benefits.
Can I use the all fours position with an epidural?
A modified version may be possible depending on the level of your epidural and your mobility. Some women can be supported into a hands-and-knees position with the head of the bed raised and pillows for support. Discuss this option with your nurse or midwife. Side-lying with a peanut ball is another alternative that provides similar pelvic opening benefits when mobility is limited.
Sheree DiBiase
Sheree DiBiase has been a physical therapist for over 40 years, specializing in pelvic floor rehabilitation and prenatal care. She is the founder of Lake City Physical Therapy and the creator of the Pelvic Floor Pro app. Sheree has helped thousands of women prepare for labor and recover postpartum through evidence-based exercise programs.