“It is best practice for hospitals, obstetric providers, and nurses to support women in their right to choose positions for pushing and delivery.”
– Evidence-Based Birth
When we are looking at different positions for the duration of labour, as well as the birth, many things need to be considered. As I go through the history of the supine position, evidence and options, please keep in mind I am speaking with consideration that no epidural has been administered in these circumstances.
I understand that there are many things in life we cannot control. The definite outcome of birth and how it unravels is one of those. However, there are so many things we can take responsibility for to really support the outcome we desire.
Contrary to what the media may show, positions in labour that coincide with supporting gravity, are incredibly helpful and should be strongly considered as one of the tools for your birth.
In my research, I came across an incredible paper called ‘Perinatal Lessons From The Past’. It speaks to the origins of woman birthing in the supine or recumbent position. Though many may believe it was the arrogance of King Louis XIV of France who demanded this position, this paper concludes that the French Obstetrician, Francois Mauriceau (1637-1709) substituted the common birthing stool with a bed. After reading Aristotle’s Experienced Midwife, written around 350BC, the author of ‘Perinatal Lessons From The Past’ then connects that Obstetrician Francois had actually gained this position recommendation from Aristotle. Therefore, the origins of the recumbent or semi-recumbent position can truly be dated back to 350BC! We can see through paintings and writings that since then, many upright positions have taken precedence. Did Francois Mauriceau, therefore, reinforce the importance of the birthing person laying down?
Image sited from ‘Perinatal Lessons From The Past’.
Jumping past 2000 years it seems it is still a common and preferred birthing position for our hospital systems and the convenience of our nurses, midwives, and doctors. Though it may be deemed necessary for some medical aid, almost all situations can offer a way for birthing people to stay upright, or semi-upright, where gravity, and increased space in the pelvis, can continue to support them and their baby.
So what’s the evidence?
During the first stage of labour:
- Shorter first stage by one hour and twenty minutes
- Reduced risk of cesarean birth
- Reduced use of epidural
- Less chance of babies being admitted to the neonatal unit
See more at: Mother's position during the first stage of labour
During the second stage, pushing and postpartum:
- A reduced length of time pushing
- Fewer assisted deliveries
- Fewer episiotomies
- No difference in serious perineal tears
- Fewer babies with fast or irregular heartbeats that indicate distress
- Squatting increases pelvic outlet by approximately 20%
- More effective contractions
- May reduce pain
- Increased satisfaction of birth experience
- All fours may resolve concerns of shoulder dystocia
- May enhance rotation of an occiput posterior fetus
- Less use of artificial oxytocin
- Decreased risk of postpartum urinary incontinence
See more at: Evidence on: Birthing Positions - Evidence Based Birth®), A review and comparison of common maternal positions during the second-stage of labor - ScienceDirect, Women’s position for giving birth without epidural anaesthesia | Cochrane
Taking all of that into account, I bet you are sitting there wondering what positions you should take with you into the birthing space. Here are some great examples, but ultimately FOLLOW YOUR INTUITION. It is such a powerful tool, especially during a period of transcendence and out-of-body experience. You know best. If something does not feel right, follow your gut, and change it to what feels right.
Standing upright, hanging off partner, supported by partner
Squatting, kneeling upright, hands and knees, kneeling over bed, polar bear (if feels right)
Knees on bed leaning against upright bed, using hospital bar on bed
Birth seat, CUB, fitball, sitting on the toilet or backward on seat
Water immersion or shower
Props to help:
- The Rebozo
- The CUB (Comfortable Upright Birth)
- Birth Stool/Seat
- Fit ball/Birth ball
- Bar on the hospital bed
- Any seat/stool
- Yoga mat for knees and hands on the ground
Though I have tried, I, unfortunately, am no artist. Below are some examples of labour position posters created by talented others (with credit attached).
A great book I recommend for learning mobile birth positions is Active Birth by Janet Balaskas. If time and talent permits, create a poster with your partner of all the positions you think you may like to try. Take that with you to the hospital, birth centre, or birth space and have it in view for reference throughout the labour and birth.
If you have hired a doula for birth preparation or birth support, organise a session with them to go through various birthing positions and practice how your partner can aid in each one.
Independent childbirth classes will touch on supportive birthing positions also. If you're interested in getting involved in one, see my post about Independent Childbirth Education to find Australian-based organizations - Independent Childbirth Education; Why and where can you find it? (intuitivebirth.com.au)
I hope this helps in some form to motivate various positions for your birth! I truly believe that what feels best and most comfortable for you is the way to go. It is your body and baby doing the work to birth, and therefore you have the greatest insight into what will work and what will reduce complications. Trust yourself!