Birthing Positions – what is the best position?
There has been much controversy over the years about what is the best birthing position, so I have researched this controversial topic and made a summary for you.
A little history lesson for you…. The horizontal position such as; lying on your back, semi-recumbent or the lithotomy (lying down with legs in stirrups) has been the norm in Western cultures for the last 200 years. Prior to this, cultures extensively used upright ‘vertical’ positioning, with the first documented maternal birth position recorded at the Temple of Esneh in Egypt, showing Cleopatra in a kneeling position.
In a 1961 survey that questioned 76 traditional cultures, only 14 of those adopted a horizontal birthing position. In Europe around the 16th century, midwives were the only attendants allowed during childbirth, until surgeons started to compete with midwives creating an interdisciplinary rivalry. In difficult life-threatening cases, women were required to adopt a semi-recumbent position to facilitate surgical access and a safer delivery. This led to the development in 1598 of the birthing beds. By the 17th century, the semi-recumbent birthing bed grew popular, as it was proposed to be more comfortable for the mother, helped to facilitate labor and allowed easy access for forceps. It is believed that forceps delivery may have been an important factor in the retention of these horizontal positions. It appears that this position was promoted with no sound evidence or research into its appropriateness, and was based on convenience. In 1996 the World Health Organisation recommended upright ‘vertical’ positions and that women should be able to choose their position of choice.
Think back to all the movies you may have watched growing up (even more present-day movies) whenever there is a birthing scene, it is in that semi-recumbent horizontal position. More recently there has been increasing interest into birthing positions that are ‘ideal’.
The second stage of labor is the most stressful part of childbirth for the mother, baby and midwives. The second stage of labor is defined as beginning with complete dilation of the cervix (10cm) and ending with the delivery of your baby. The second stage of labor occurs when you are actively pushing simultaneously with your uterine contractions, it is noted that the more prolonged second stage labor is highly correlated with increased risk of postpartum haemorrhage, caesarean deliveries, third- and fourth-degree tears of the perineum, and neonatal complications. Certain maternal positions during second stage labor have potential benefits in promoting optimal outcomes.
Let’s look at the six common birthing positions which can be defined as either horizontal or vertical.
Vertical Positions – where the women’s feet are on the ground
Horizontal Positions – where the woman lies on the bed and the weight is supported by her lower back.
This position is where the woman is lying on her back with her legs bent, either on the bed, in stirrups or held by midwives and/or supporters.
The woman lies flat on her back or with her torso slightly raised, legs either out straight, bent with feet flat on the bed, in leg supports or drawn back towards her shoulders.
3. Lateral (side-lying):
The woman lies on her side with both hips and knees bent and a pillow between her legs or her upper leg supported and raised.
Where a woman will sit completely upright on a chair or stool, or semi-sitting with her torso leaning forwarded.
This can vary from upright kneeling to 4-point kneeling on both hands and knees. This is where the women either kneels leaning over the bed or object or being supported by her hands.
The woman squats with her knees bent, with all the pressure being placed through her feet. This position is difficult to sustain for long periods of time due to fatigue.
Benefits of Upright ‘Vertical’ Positions:
There has been increasing interest and studies into the benefits of upright positions after studies confirmed that the upright positions have more benefits in accelerating the progress of labor than horizontal positions. In a recent study, it was evident that these positions reduce the duration by a mean of 6.6 minutes compared to horizontal positions. Other benefits include:
Significant reduction in instrumental deliveries (forceps, vacuum).
Promoting better alignment of the baby passing through the pelvis, assisting with delivery.
Contractions coupled with gravity can help to facilitate and fast track labor. It also allows your cervix to open quicker.
Upright positions allow increased mobility and allows for maximal relaxation of the pelvic floor.
Perineal damage such as need for episiotomy and tears are reduced as it allows your tissues to stretch more evenly.
Desseauve, D., Pierre, F., Gachon, B., Decatoire, A., Lacouture, P., & Fadet, L. (2017). New Approaches for Assessing Childbirth Positions. Journal of Gynaecology Obstetrics and Human Reproduction, 189-195.
Dundes, L. (1987). The Evolution of Maternal Birthing Position. American Journal of Public Health, 636-640.
Huang, J., Zang, Y., Ren, L.-H., Li, F.-J., & Lu, H. (2019). A review and comparison of common maternal positions during second stage of labor. Internation Journal of Nursing Sciences, 460-467.
Nieuwenhuijze, M., Low, L., Korstjens, I., & Largo-Janssen, T. (2014). The Role of Maternity Care Providers in Promoting Shared Decision Making Regarding Birthing Positions During the Second Stage of Labour. Midwifery, 107-114.
Ondeck, M. (2014). Healthy Birth Practice #2: Walk, Move Around and Change Position Throughout Labour. The Journal of Perinatal Education, 188-193.