Birthing Positions–Should I Really Be Giving Birth On My Back?
Hi, Bestie! If you joined me last week, you’ll remember that we talked a lot about the importance of positioning during labor and birth. By placing your body in different positions, you can give yourself and your baby an advantage during the stages of labor and delivery. Today, let’s pick up where we left off and chat about birth positions and how you can find the best position for you.
Even though lots of soon-to-be parents attend birthing classes to prepare for labor and delivery, even the most prepared folks don’t realize the options that exist for birthing positions, especially for those who plan to have an epidural. In the Western world, it is exceedingly common to give birth in what is called the Dorsal Lithotomy position where you are lying on your back with your knees bent up toward your chest. While all birthing positions are perfectly valid and you should choose whatever position makes you feel most comfortable and safe, there are many different options out there. I’ve come to realize that a lot of pregnant people just assume they will be giving birth in a Dorsal Lithotomy position and don’t even consider that there could be a more beneficial position for them.
Why does birthing position matter?
During labor and delivery, the baby moves through the pelvis and exits through the vaginal canal. By using appropriate positions and exercises, you can help encourage the movement of the fetus. During Early Labor, it is ideal to use positions that help open the pelvic inlet (the top ring of the pelvis), while during Stage 2 of labor, it is more important to use positions that open up the pelvic outlet (the bottom ring of the pelvis) to help the baby to exit. Let’s talk about some of the different birthing positions you can use during delivery and the potential positives and negatives of each.
SUPINE/DORSAL LITHOTOMY: Dorsal Lithotomy involves lying on your back with your hips and knees flexed to around 90 degrees each. You may have assumed a similar position during a routine visit to the gynecologist where you placed your feet in padded stirrups. During childbirth, your partner, medical provider, or other helpers may help to hold your legs in a flexed position, especially if you have received an epidural and do not have sensation in the lower half of the body. This is the most common birthing position worldwide (1).
Pros:
This is the most common position used, so people are used to it and many assume they will give birth in this position. It is often what people think about when they imagine giving birth (2)
Folks who have received an epidural may feel most comfortable in this position.
Cons:
The position does not allow maximal opening of the pelvis, sometimes making birth more difficult.
The position is associated with an increased rate of episiotomy and tearing (3, 4).
The position does not benefit from gravitational assistance and forces the mother to fight gravity (5).
Dorsal Lithotomy position
SIDE-LYING: “Side-Lying” is a broad term that is used to describe any range of positions in which a person is lying on one of their sides. In Side-Lying, one can have the hips and knees flexed or straight, a pillow between the knees, a hand lifting the top leg, a support person helping to hold the top leg, a forward or backward lean, or any other possible adjustments for comfort.
Pros:
This position can be utilized by both folks with and without epidural (1). The positioning of the body on the side allows for better movement of the sacrum and coccyx as the baby descends through the birth canal.
Side-Lying postures have been linked to a shorter Stage 2 of labor, fewer episiotomies and perineal tearing, and fewer instrument-assisted deliveries in relation to the Dorsal Lithotomy position (1).
Cons:
This position does not benefit from gravitational assistance.
Side-Lying position with support
UPRIGHT SQUATTING: This is another category that can take many forms. Folks who assume a squatting position will likely use a birthing bar or other structure for support. It is also possible to give birth sitting in a squatted position on a birthing stool.
Pros:
Upright Squatting is a gravity-assisted position and the pull of gravity can help with both the labor and delivery stages of labor (1).
According to a study by researchers Satone and Tayade, ”upright [birthing] positions have been linked to psychological advantages like decreased pain perception, an increased sense of control, more equitable communication with the delivery attendant, and increased partner involvement” (1).
Upright postures have been linked to a shorter Stage 2 of labor, fewer episiotomies, and fewer instrument-assisted deliveries in relation to the Dorsal Lithotomy position (1).
Cons:
It can be difficult to maintain a squatted position for long periods of time and therefore is not always sustainable for the duration of labor (1). It places a great deal of pressure on the knees and back of the birthing person (1). The use of a birthing stool provides a bit more support for those who wish to be in an upright squat position but cannot maintain a standing squat position.
This position typically cannot be utilized by folks who have received an epidural in most cases.
Squatting with a birthing bar
KNEELING/HANDS AND KNEES: A kneeling position can take various forms. Folks might find themselves on hands and knees or using a birthing ball to support the upper body while kneeling.
Pros:
When kneeling with knees close together and feet wide, the pelvic outlet opens up which can be beneficial in Stage 2 of labor.
This position is conducive to partner support and pain management including a partner providing compression to the hips which may help manage the pain of labor.
There is no external pressure on the pelvis as there is in supine and Side-Lying positions, which allows the pelvis to move freely.
Cons:
This is not a gravity-assisted position (or it is very minimally gravity-assisted) as it is not an upright posture.
This can be a difficult position to assume for folks with epidural.
Hands and knees position in a birthing pool
Your pelvic health physical therapist can help you figure out which birth position is best for you! Using surface electromyographic biofeedback, they can test birthing positions and find which position allows your pelvic floor muscles to relax best. Also, your therapist can help you to create a plan for birth positions. If you are giving birth in a birthing center or at home, you are likely not planning on receiving an epidural. In those cases, a birthing parent can more easily move into positions that serve them during the birthing process. However, if you are giving birth in a hospital and/or planning on receiving an epidural, it is essential to have a plan for your birth position. This is because an epidural will result in less mobility and requires the support of others to achieve the position in which you want to give birth. If you do not have a plan, your providers may assume you will be giving birth while lying on your back even if it is not your preference. Remember, all birth experiences/preferences are valid and no method is incorrect! The purpose of this chat is to provide you with knowledge about the available options so that you can pick the one that’s right for you.
If you’ve given birth, which position did you find worked well for you? If you have given birth multiple times, did you change positions from one birth to the next? I’d love to hear about it!
XOXO,
Your Pelvic Bestie
References:
Satone PD, Tayade SA. Alternative Birthing Positions Compared to the Conventional Position in the Second Stage of Labor: A Review. Cureus. 2023 Apr 21;15(4):e37943. doi: 10.7759/cureus.37943. PMID: 37223195; PMCID: PMC10202683.
Why do women assume a supine position when giving birth? The perceptions and experiences of postnatal mothers and nurse-midwives in Tanzania. Mselle LT, Eustace L. BMC Pregnancy Childbirth. 2020;20:36. doi: 10.1186/s12884-020-2726-4.
Perineal outcomes and nurse-midwifery management. Lydon-Rochelle MT, Albers L, Teaf D. https://doi.org/10.1016/0091-2182(94)00086-L. J Nurse Midwifery. 1995;40:13–18. doi: 10.1016/0091-2182(94)00086-l.
Supine position compared to other positions during the second stage of labor: a meta-analytic review. De Jonge A, Teunissen TA, Lagro-Janssen AL. J Psychosom Obstet Gynaecol. 2004;25:35–45. doi: 10.1080/01674820410001737423.
A review and comparison of common maternal positions during the second-stage of labor. Huang J, Zang Y, Ren LH, Li FJ, Lu H. Int J Nurs Sci. 2019;6:460–467. doi: 10.1016/j.ijnss.2019.06.007.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
