Choosing a Birthing Position
Some care providers are not comfortable delivering babies in non-standard positions (i.e. other than lying on your back in the bed with your legs up), or off the bed. Find out whether your care provider will be able to be flexable about alternative birthing positions and whether they will permit you to choose your birth position, even if that means the birth will occur off the bed. Are they aware of the many benefits of alternative birth positions that decrease the perineal tearing rate?
Will I be able to birth in any position, including squatting, leaning forward, on hands and knees, or off the bed while standing?
When women birth normally, physiologically, they instinctively assume forward leaning or hands/knees positions to birth to allow for the natural way of opening the pelvic outlet—the normal flaring outward of the coccyx bone to make more room for the baby to come out. Most physicians, and even some midwives insist on “performing” the birth on the bed, or even breaking the bed apart (removing the bottom portion of the bed) with your feet in stirrups, so you are pushing the baby uphill in the wrong direction, in the “stranded beetle position.” If you are forced to birth lying on your back, the bed will be in the way and will restrict the normal mechanism of flaring out of the coccyx bone to enlarge the pelvic outlet. Therefore, to compensate for this inability of enlarging the pelvic outlet normally to make more room for the baby to come out, your birth attendant may need to open the pelvic outlet surgically, by cutting an episiotomy (which is a deep second-degree cut through the main muscles of the perineum that is painful and can lead to extensions into the anus and other long standing pelvic floor problems), or needing a surgical vaginal birth by vacuum extraction or forceps with their associated risks to the baby and the mother’s tissues. A number of trials (Stewart et al 1983, Liddell and Fisher 1985, Chen et al 1987, Johnstone et al 1987, Gardosi et al 1989ab, Stewart and Spiby 1989, Crowley et al 1991, Allahbadia and Vaidya 1992, Bhardwaj et al 1995) suggest that an upright (vertical) position or a lateral tilt during the second stage of labor show greater advantages than a dorsal (lying down on back) position. The upright position gives less discomfort and difficulty in bearing down, less labor pain, less perineal/vaginal trauma and wound infections. In one trial a shorter duration of the second stage was observed in the upright position. With regard to the fetal outcome, in some trials there were fewer Apgar scores below 7 in the upright position. It is much easier and safer for the mother to birth standing, squatting, leaning forward, or to be on hands and knees to make more room in the pelvic outlet instead of cutting a woman deeply with an episiotomy to enlarge the pelvic outlet surgically. In all of human recorded art history depicting birth, women are always represented as being upright with the birth attendant below her to receive the baby.
- Stewart P, Hillan E, Calder AA. Upright posture and the efficiency of labour. Lancet 1978; i:72-74.
- Stewart P, Spiby H. A randomized study of the sitting position for delivery using a newly designed obstetric chair. Br J Obstet Gynaecol 1989; 96:327-333.
- Liddell HS, Fisher PR. The birthing chair in the second stage of labour. Aus NZ J Obstet Gynaecol 1985; 25:65-68.
- Chen SZ, Aisaka K, Mori H, Kigawa T. Effects of sitting position on uterine activity during labour. Obstet Gynecol 1987; 79:67-73.
- Johnstone FD, Abdoelmagd MS, Harouny AK. Maternal posture in second stage and fetal acid-base status. Br J Obstet Gynaecol 1987; 94:753-757.
- Gardosi J, Sylvester S, Lynch CB. Alternative positions in the second stage of labour, a randomized controlled trial. Br J Obstet Gynaecol 1989a; 96:1290-1296.
- Gardosi J, Hutson N, Lynch CB. Randomised, controlled trial of squatting in the second stage of labour. Lancet 1989b; 2:74-77.
- Crowley P, Elbourne DR, Ashhurst H, Garcia J, Murphy D, Duignan N. Delivery in an obstetric birth chair: a randomized controlled trial. Br J Obstet Gynaecol 1991; 98:667-674.
- Allahbadia GN, Vaidya PR. Why deliver in the supine position? Aust NZ J Obstet Gynaecol 1992; 32/2:104-106.
- Bhardwaj N, Kukade JA, Patil S, Bhardwaj S. Randomised controlled trial on modified squatting position of delivery. Indian J Maternal and Child Health 1995; 6(2):33-39.