Through history birthing positons changed and with the increase in medical interventions during birth the use of obstetric bed became more common. Lithotomy position is mostly used so that midwives and obstetricians could more easily conduct birth. But women report that birth in lithotomy position leads to higher pain scores, it’s uncomfortable and difficult and it’s associated with increased risk for birthing person and foetus as well as increased likelihood of perineal injuries. Recently birthing persons became more aware of physiological advantages of mobility and position changes in birth. Upright positions have a beneficial effect on the experience of childbirth, they promote uterine contractions while reducing pain associated with birth, reduce the duration of childbirth, reduce perineum injuries as well as the use of episiotomy and ensure better maternal and neonatal outcomes. In addition to that, upright positions are also beneficial in event of childbirth complications. Therefore, one of the main roles of the midwife is to encourage the birthing person to take upright positions and to change positions freely. Birthing person should choose positions that they found most comfortable and the birthing environment should not be limiting in the manner of lack of privacy and equipment. It is also important for the midwives to have a deep understanding of mechanism of birth so they could accommodate any positions that the birthing person assumes, whilst protecting their own health. For that reason, the midwives should have assistance while positioning the birthing person that has had epidural analgesia and should use ergonomic positions in the process. The role of the midwife is to facilitate physiological birth by encouraging physiological mechanisms and avoiding routine interventions which can be accomplished with the use of upright positions.