Positioning Matters

Mom’s position during labor matters, it matters a LOT! Did you know that being on your back in the lithotomy position provides 30% less pelvic opening than almost every other position for delivery? When delivering your baby 30% more space is a pretty big deal. Yet most women deliver in that position because they assume it is the “right” position, its the position they saw on tv, the position during their exams, the position that just seems normal.

When left to make the decision themselves, without any suggestions or even a room set up to suggest being in bed, very few laboring women choose or remain in a semi-seated or lithotomy position.¹ They often choose to be upright and leaning forward, a supported squat, all fours, or other positions that naturally allow for more pelvic opening. Laying on your back during pregnancy is often discouraged because the uterus rests on the intestines and major blood vessels (aorta and vena cava).² It makes little sense to suggest the discomfort and risk of placing too much pressure on major blood vessels would not be an issue during labor. Many women find contractions more painful while resting on their backs because you are adding the strength of contractions to the normal discomfort associated with being on your back during the third trimester.

Here is a pretty simple illustration of why being flat and keeping hips symmetrical creates a smaller space while positions that allow for asymmetrical hips create more space. Being upright, well that is just utilizing gravity, no illustration needed.


The first image illustrates the pelvic opening with symmetrical hips and the second image illustrates having asymmetrical hips. The jar is the same size, its exterior unchanging, but if you notice the water line there is more space in the picture on the right. Add in the use of gravity by not lying flat and the lithotomy position looks even less favorable.

Being active during labor reduces the length of labor, lessens the need for medicinal pain relief, and reduces the risk of tearing and pelvic floor issues. It has been known since the 1930’s that the supine position reduces the pelvic space by 30%,³ this information is not new it just needs to be utilized. Some studies show the second stage is a much as 40% shorter when women labor in an upright position. Get up and move, stay off your back and utilize as much pelvic space as you can. Your position matters!

On a final note, a wonderful quote from Active Birth by Janet Balaskas, “By deciding to have an active birth you will be reclaiming your fundamental power as a birth-giver, a mother, and a woman. You will be giving your baby the best possible start in life and a safe transition from the womb to the world. Should any unusual difficulty or complication arise, you will be free to make use of the safety net of modern obstetric care, knowing that you have done your very best and also knowing that this is your choice and that intervention was really necessary. In this way, even the most difficult birth can be a positive experience.”

1Odent, Michel. Birth Reborn. New York: Pantheon, 1984. Print.
2″Positions During Pregnancy.” American Pregnancy Association. N.p., n.d. Web. 30 Aug. 2013.
3 Balaskas, Janet. New Active Birth: A Concise Guide to Natural Childbirth. [Hammersmith, London]: Thorsons, 1991. Print.