What are the best positions during labour?
There are a whole bunch of ideas we have about the way childbirth happens. And part of becoming educated and prepared for birth is considering where those ideas came from and if they are relevant and helpful to you.
Contrary to what Hollywood and mainstream TV shows us continually, and perhaps also what our own mothers may have suffered through, there is very little logic to labouring and/or birthing on our backs. The common image of a woman screaming while she lies supine, even with feet in stirrups is one of the greatest birth misconceptions.
The notion itself is believed to have arisen when Henry the 4th decided to watch his poor wife give birth so that it was easier for him to peek behind a curtain and see the sex of his child before anyone else.
This mainstreamed lithotomy position is flat back with the legs separated, feet flexed, and supported in raised stirrups. Contrary to its popularisation, even Robbie William and Ayda Field shared their moments here it is the most uncomfortable, ineffective and potentially dangerous position for both mum and baby to labour in and also push in.
When a mum lies on her back during labour there is:
- Minimised space in the pelvis, it becomes up to 30% smaller
- Forced stretching of the pelvic floor, by 3 times what is required
- Prolonged lack of oxygenation for the baby by a longer pushing stage
- Increased pain for the mother via pressure on the back, which can cause her and baby to go into distress
Simply lying flat on our lower back or sacrum means that our tailbone can no longer move back, out the way for our baby. Most women will instinctively stand and rock their hips during labour and when they are yielding to the downward pressure of their baby’s descent during a contraction they bend their knees and tilt their bottom back, while standing.
You can try this fun ‘how big is my pelvis test’ at home:
With a tape measure we can discover exactly how much your tailbone will potentially move out of the way. Simply stand up straight and with your knees locked, measure from your pubic bone to any point on the tailbone. I get 16cm. (Feel those two points, so that you can go back to them in a minute.)
Next, stand with your feet a bit wider than your hips, bend your knees and tilt your bottom back. Now measure again from those two same points. What do you get? I get 20cm.
If you are doing it correctly you will get anywhere between 4-5 cm increased space just via that positioning of your body. So even with the hormones of labour, we might even create more space!
Lying back requires a mum to push her baby up the birth canal and puts a lot of unnecessary strain on her pelvic floor. If you think about your birth canal it does not go straight down, but rather back slightly and then forward, towards the pubic bone. This means from a supine position we are lifting a 3-4kg weight up a hill without any help from gravity and also needing to stretch our perineum and pelvic floor muscles three times as much.
Studies show that when women are given the choice, freedom and encouragement by their caregivers to find what is most comfortable for them during the pushing/second stage – 60 % of women choose an all fours stance. This can be in the bath, on the floor with mats or even on a hospital bed. Some mums will birth standing up with or without one leg on a step, some lean back floating in the bathtub and some choose a deep squat, but the majority will select an all fours position. How many times have you seen a woman birthing in this position in mainstream media?
From an all fours position:
- A woman naturally brings her hips back towards her feet when pushing (thus creates a deep squat) and the tailbone tilts out of the way by at least 4-5 cm and the two sit bones (ischial spine) also move across to the right and left, widening the pelvis even more.
- The birth canal flows downwards and so a baby is helped by gravitational pull and less effort is required from mum, which in turn allows the perineum to stretch easily without added pressure or swelling, that occurs when lying on our back.
Cochrane review (a culmination of the world’s best randomised controlled trials) tell us that ‘walking and upright positions in the first stage of labour reduces the duration of labour, the risk of caesarean birth, the need for epidural’.
Understanding that you can create up to 30% more space in the pelvis by being upright and free to move during labour means there will be a lot less effort for you and baby. Similarly the more we move, the more we are distracting ourselves from pain and stopping our muscles from tightening. We are also allowing gravity to help our baby down and along the birth path.
So remember to be as active as you like during labour and that everything in the house and hospital is a prop for your comfort. Having stations set up for comfort around the space such as mats, bean bags, fitballs, bolsters and chairs etc will make birthing more instinctive and easier for you.
Don’t underestimate the power of movement during your birth. To see images and videos of how you can utilise active birthing in your labour with the help of your partner (and hopefully be more useful and Robbie Williams) visit the She Births® Full Online Course here.