Hip Positioning During Birth: Internal or External Hip Rotation?

As a pregnancy and postpartum exercise therapist, I work with expectant parents to explore how proper hip positioning can support labor and delivery. The body is designed for birth, but how we position the hips can play a crucial role in easing the process and making the experience more efficient. One of the key aspects of positioning is understanding the difference between internal and external hip rotation.

The Basics of Hip Positioning

Our hips are dynamic joints, and their positioning affects the alignment of the pelvis, the birth canal, and the baby's descent. When we focus on the movement of the hips during labor, we’re considering how these rotations can open the pelvic inlet and create the most space for the baby to move into the birth canal. Both internal and external hip rotation can influence the way the baby engages, rotates, and moves down through the pelvis.

Internal Hip Rotation refers to when the thigh bone (femur) turns inward toward the midline of the body. This movement reduces the available space in the hip joint and the pelvis but may be necessary when the baby’s head is aligning with the birth canal.

External Hip Rotation occurs when the thigh bone turns outward, away from the body’s midline. This movement opens the pelvis and creates more room for the baby to move down and out, particularly during labor.

Early Labor: Relaxation and Internal Rotation

In the early stages of labor, the focus is on maintaining a calm, relaxed pelvis that allows for the baby to engage and move into a good position. Internal rotation of the hips can help facilitate fetal rotation and positioning. For example, during contractions, you might find that your body naturally wants to rotate in a way that encourages the baby to move into the ideal position, with their head downward.

Gentle movements like swaying the hips or rotating the pelvis while on hands and knees can help guide the baby into an optimal position while encouraging internal hip rotation. At this stage, you also want to avoid positions that overly restrict hip movement, as this can limit the pelvis's ability to open and shift in response to labor.

Active Labor: Internal Rotation and Opening the Pelvis

As labor progresses and the baby begins to move down through the birth canal, internal rotation of the hips becomes incredibly valuable. internal rotation helps to widen the pelvic inlet, which allows more room for the baby to navigate through the pelvis.

The Final Push: Facilitating Internal Rotation

As you move into the final stage of labor and the baby is about to be born, internal rotation continues to play a key role in making room for the baby to pass through the birth canal. Being on your hands and knees, squatting, or even leaning forward can encourage the hips to rotate internally, giving the baby more space to emerge.

See how this graphic by @mamastefit of internal vs external rotation open your pelvis!

The Power of Hip Positioning During Birth

Understanding and utilizing internal and external hip rotation during labor can have a profound effect on the birth process. Whether you’re in the early stages of labor or pushing your baby into the world, being mindful of how your hips are positioned can facilitate a smoother, more effective delivery. The key is to stay fluid, explore different positions, and trust your body to guide the way.

As a pregnancy and postpartum corrective exercise specialist, I encourage all expecting individuals to educate themselves on the mechanics of the pelvis, practice movement techniques, and feel empowered to use hip rotation to support their birthing experience. By optimizing hip mobility, you’re giving yourself the best opportunity for a positive birth and a strong recovery afterward.