Birth Positions:
All-Fours / Hands and Knees

Even though they are on separate pages, the kneeling and hands-and-knees / all-fours birth positions are quite similar. As always, read what you can and so when the time comes you know your natural birth options.

Birth positions: All-fours / Hands-and-Knees


The all-fours position is the one you might assume for washing the floor – amongst other things.


typical all fours position
Typical All-Fours /
Hands-and-Knees position
Hands-and-Knees / All-Fours position with a birth ball
Hands-and-Knees /
All-Fours position with a birth ball
  • When in typical all fours position, the general idea is to keep your arms vertically below your shoulders, not too far forward or back or wider than your shoulders so that you don’t waste energy holding yourself up, but allow your body to rest on your arms. For the final stages you may need to widen your knees to open your pelvis. Find whatever is comfortable for you.
  • You might need a pad or cushion under your knees, especially if you intend to rock in this position.
  • You can rest your upper body on a chair or birth ball.
  • Some find it helpful if a partner supports and slightly lifts their belly with a sling or long piece of fabric and rocks the sling from side to side.
  • Some like to move from a traditional hands and knees position into one where you keep your hands where they are and bend your knees so your bottom ends up higher than your head.
  • You may want to arch your back from time to time (as though someone is pulling your belly button up through your spine) as this may help with pain relief.
  • Advantages:

Alternative to Hands-and-Knees position
Alternative to Hands-and-Knees position
  • Helps to relieve the pain of back labour. (1, 2)
  • Because it is gravity neutral it may help a posterior baby to turn.
  • Fewer tears because there is less pressure on the perineum. (3, 4)
  • This position is great for big babies!
  • Can help if umbilical cord prolapsed is a problem as it can prevent the umbilical cord from coming out further or can even help it retract. (Cord prolapse is when the umbilical cord comes out before the baby, possibly cutting of the baby’s oxygen supply.)


  • You may feel exposed or vulnerable in this position. It may help to have a skirt or wrap of some kind if this is the case.


1. Hunter S, Hofmeyr GJ, & Kulier R. Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev. 2007 Oct 17;(4):CD001063. Back.

2. Stremler R, Hodnett E, Petryshen P, Stevens B, Weston J, & Willan AR. Randomized controlled trial of hands-and-knees positioning for occipitoposterior position in labor. Birth. 2005 Dec;32(4):243-51. Back.

3. Kelly FW, Terry R, & Naglieri R. A review of alternative birthing positions. Journal of the American Osteopathic Association. 1999 Sep;99(9):470-4. Back.

4. Terry RR, Westcott J, O'Shea L, & Kelly F. Postpartum outcomes in supine delivery by physicians vs nonsupine delivery by midwives. Journal of the American Osteopathic Association. 2006 Apr;106(4):199-202. Back.

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