For most of human history, laboring women were free to move about as they pleased during labor. They were able to adopt upright birth positions that felt comfortable and eased the pain of contractions.
It wasn’t until the 1700s that lying down to give birth (the supine position) became the norm, thanks to obstetricians who wanted easier access for examinations. They also found it a more convenient birthing position to perform procedures such as episiotomies or forceps deliveries.
Birth moved from home into hospital during the 1900s. The medical model of maternity care became entrenched in society, along with the expectation that women would labor in the supine position – lying flat on their backs and sometimes with their legs in stirrups.
There was a complete lack of evidence to support the passive supine lying. It is a physiologically dysfunctional birth position – one of the worst birthing positions – that simply came down to doctor preference. Subsequently, it became the way doctors were trained.
However, the World Health Organization (WHO) now states that there are plenty of reasons not to lie down while giving birth, and these are fully backed by evidence.
Upright positions
Upright positions include various birthing positions a woman can adopt, during labor, where her pelvis, aided by gravity, is in the best possible position to help the baby out through the birth canal. When it comes to giving birth there are many different maternal pushing positions.
Active and upright positions include birthing positions pregnant women might adopt where their hips are significantly higher than their knees. Standing up, sitting upright, and kneeling are all upright maternal positions that will facilitate birth. These are also known as flexible sacrum positions.
There is an exception to this ‘rule’: the squatting position is also considered an upright birthing position but one where the knees are usually higher than the pelvis. The squatting position is an upright position that’s especially useful at the end of the second stage of labor, if the baby is finding it difficult to negotiate the birth canal.
There are also some gravity-neutral positions, such as the side-lying position, which are good alternatives to upright positions when the woman’s mobility is impeded – for example, if a woman is disabled, or has had a heavy dose of epidural analgesia.
Giving birth upright – 9 big benefits
There are significant advantages of upright positioning for the laboring woman:
#1: Allows gravity to assist baby’s descent
Why work harder than you need to? Your uterus contracts out — or forwards — from your body. When you’re upright, you can work with gravity and your body’s natural functions in labor. When you’re lying down, you’re bearing the brunt of weight and force, which means going against gravity.
#2: Fewer interventions
When you’re giving birth upright, making use of gravity, and using your muscles more effectively, you’re less likely to need interventions, such as forceps or episiotomies. When you’re working against gravity in a dysfunctional position, both you and your baby are more likely to need help.
#3: More efficient contractions
When you’re upright, leaning forward, and working with gravity, your contractions and pushing efforts will become much more efficient. The contraction starts at the top of the uterus and moves downwards to dilate the cervix. There isn’t a better position to help the cervix dilate than an upright position. If you’re lying on your back, your uterus will be contracting upwards, which is not working with your body but against it.
#4: Less pain
Labor contractions guide laboring women towards the best position to adopt in the different stages of labor. Women who can move freely during labor will make frequent position changes. They’re looking for the most comfortable position at any given time.
The least painful position is the most favorable for the baby to descend through the birth canal. When you’re off your back, you’ll experience less pain than you will when giving birth lying down. This is because you have all the weight on your back and you’re working against gravity. Change position as soon as you need to, as this will help your baby’s downward movement and will give you a much less painful birth experience.
#5: Shorter labor
When you’re working with gravity, in a position in which your body and your baby are designed to work well, your labor is likely to be much shorter. That means it is likely to be closer to ‘normal’, because lying down can slow your labor down.
Women’s childbearing experiences are backed up by research that shows that labor is considerably shorter in nulliparous women (women who are pregnant for the first time) when they adopt upright positions during labor.
#6: Better oxygen supply to your baby
When you’re lying on your back, you’re bearing the full weight of the baby, your uterus, the placenta, and all that comes with it. Doing so puts pressure on important blood supplies in your own body. Compressing the blood supply also compresses the oxygen supply to your baby. By being upright, you’ll provide a better oxygen and blood supply to your baby. Birth outcomes are better, which means that your baby will be less likely to experience fetal distress and more likely to have a normal birth. Fetal distress that cannot be rectified quickly usually results in an emergency cesarean section.
#7: Mothers’ overall satisfaction increases
If giving birth upright makes the actual birth easier, shorter, and less painful, then a mother’s overall satisfaction with the birth increases. And that’s no surprise, given what we’ve already learned: that an upright labor will really increase your chances of a normal vaginal birth, reduce recovery time and give you an oxytocin boost – all very important for a good start to motherhood.
#8: Significantly increases pelvic space
Lying down reduces pelvic diameter by about 30%. If you have concerns about having a big baby (which you shouldn’t, because your body is cleverly designed to birth), lying down will not help your body to open as well as it could. Being upright opens up your pelvis, whereas lying down closes it up. That’s why scans are inaccurate in diagnosing your pelvis’ ability to birth your baby. Adopt different positions and remain upright most of the time.
#9: Lying down forces the mother to push ‘uphill’
Pushing ‘uphill’, against gravity, can be ineffective and exhausting. Being upright means you’re pushing ‘downhill’ instead. Spontaneous pushing will happen easily if you’re upright and the efforts involved in spontaneous pushing should be much less in certain positions.
Why do hospitals make you give birth on your back?
Dr. François Mauriceau was a French obstetrician who invented the lithotomy position (where the woman lies flat on her back with her legs up in stirrups) at the end of the 17th century. Until then, birth had been women’s business but at that time, doctors started to intervene in birth and they perceived it as an illness that needed medical intervention.
This medicalized view of birth expanded quickly and women who gave birth with the help of a doctor would be placed into this lithotomy position to give birth.
Birth was then moved to hospitals and, soon after, giving birth upright was considered only for poor people in low income countries or for those in rich countries who could not afford medical care. Since then, any woman who gave birth on a hospital bed had to do it lying on her back.
Nowadays, obstetric health care providers are starting to realize how ridiculous it is to stop women from adopting any position they want when labor begins. Change usually takes a long time to happen. This is why, in some hospitals – especially where the obstetric directors are ‘old school’ – lying on the bed is almost a rule.
Can I refuse to give birth on my back?
Absolutely!
Please bear in mind that you are the one who has the last word on anything concerning your own body. Informed consent isn’t just about you saying yes to all the proposals the healthcare providers make. Informed consent is also about you being given all the information and making the final decision – even if it goes against the doctors’ recommended option.
No health care provider in any country has the right to force you into any position to give birth.
If you have doubts about the hospital where you’re planning to give birth, ask for an appointment to discuss your birthing options. Make a birth plan and take it with you to discuss it with the professionals. Ask a doula or any of your trusted family members to accompany you. If you leave that appointment feeling that your choices might not be respected, now is the time to look for a different option, not when active labor begins.
Giving birth upright – 5 position suggestions
Now you know why giving birth upright is much more beneficial to mother and baby, you might be wondering which positions are best.
Here are five birth positions that can promote effective contractions and an easier labor. Each of these positions can be used in the first and second stages of labor. Some positions might require the support of your partner, doula, or midwife. It’s important to remember that you make the decision about what is most comfortable and works best for you.
Upright Position #1: Standing
Gravity works best in this position. Baby’s head is able to apply even and direct pressure onto the cervix, helping dilation. Contractions strengthen and become regular. In this position, the laboring mother can hold on to her birth support partner, rock and sway, lean against walls, and so on. Slow walking is a variation of this position.
Upright Position #2: Hands and knees/leaning forward
Many women instinctively adopt the hands and knees position when in the later phases of the first stage and the pushing stage. This position is very adaptable and can include leaning forward over a birthing ball, a pile of cushions, or any handy piece of furniture, such as a table or bed. It allows for a full range of movement in your hips, such as rocking and swaying, which can increase comfort.
This position is also favoured by women who have back labor pain, due to a posterior baby (where baby is facing frontwards or his back is against your back). Hands and knees positioning during posterior labor can help reduce back pain and promote baby’s head turning into a more favorable position.
Upright Position #3: Squatting
Squatting doesn’t come naturally to women in Western cultures but it is a very powerful position to use when pushing. It’s a good idea to practice squatting during your pregnancy. Make sure you build up to it slowly, to avoid injuring yourself, and to get your muscles familiar with the position. It’s not easy to balance when you have a bump out the front, so using a wall or holding onto a doorknob can provide you with the support you need.
Squatting opens the pelvis and increases the space for baby, while allowing gravity to help baby move down without much effort.
Upright Position #4: Sitting
Some women find a lot of comfort and relief in sitting on a birth ball during labor. It allows them to rock and sway through the contractions. Sitting allows you to plant your feet wide apart and open up your hips, as well as taking pressure off your legs.
Straddling a chair and using the back as support, or even sitting on your partner’s lap and leaning forward can be very comforting. The toilet can be a great place to be during labor; it’s a place where you can feel comfortable releasing and letting go, which can help you to release and relax your pelvic floor muscles.
Upright Position #5: Lying sideways
If you have had a long labor, being able to rest without discomfort is important. Side lying allows you to relax your body without increasing pressure on major blood vessels, which can compromise blood flow to your baby. If you’ve had an epidural or need constant fetal monitoring, lying on your left side can give you the benefits of an upright position. A fast birth can also benefit from side lying (or on hands and knees), as it can help slow things down. It can also be a fantastic position from which to push baby out, particularly if you are tired and would need support to be upright.
