Many people in the Western world immediately picture a woman laying on a bed when “giving birth” is mentioned – this is known as the lithotomy position. In actual fact, this position is one of the worst to birth in, although it is unfortunately quite common. It was originally started by King Louis XIV who enjoyed watching his mistresses give birth and then adopted by medical carers because they found it easier to see and intervene in a birth when the woman was on her back instead of standing or sitting. Before this, it was much more common to give birth upright, or on a birthing chair. Unfortunately, laying on the back to birth actually increases the need for the very interventions doctors want you in this position to check for.
There are many good reasons NOT to birth while laying on your back. Here are a few:
- Being on your back closes up the pelvic outlet by up to 20-30% compared to positions such as squatting.
- Pushing on your back is quite literally pushing uphill. The birth canal curves upwards when laying down, so you’re pushing against gravity.
- Pushing on the back increases the risk of assisted birth (forceps and venthouse/vacuum.)
- Laying on the back constricts blood vessels, meaning baby and mother won’t receive the optimum levels of blood & oxygen. This also means baby is at more risk of bradycardia (low heartbeat.)
- Laboring on the back can make labor longer (because the body has to do more work to push baby out).
- Laboring on the back can often be more painful.
- If baby is in a non-optimal position (such as posterior), the baby is less likely to move into a better position while the mother is on her back.
- Birthing on the back increases the risk of pelvic, spinal and nerve injuries or prolonged pain after birth.
- Birthing on the back is more likely to lead to further intervention because medical carers judge that birth has slowed or stalled.
- Women laying on their back are more likely to feel pressured by medical carers and less in control of the situation.
So what position should you birth in?
The answer is simple – whatever feels good to you at the time. Some suggestions include:
- Side-laying, squatting, standing, waterbirth, in the shower, on a birth stool or chair, on all fours, kneeling over a birthing ball.
There are four different female pelvic shapes; gynecoid, android, anthropoid and platypelloid. Babies can also come in a range of positions varying between posterior, anterior, breech, transverse and more.
When left to find a position in which she is most comfortable, a woman will normally gravitate towards a position which opens up the birth canal in a way that suits both her pelvic shape and the baby’s position.