by Stephanie Larson, Founder of Dancing For Birth™
When you think of birth, what position jumps to mind? Is it lithotomy position―the one where the woman is lying on her back with her legs up in stirrups? Back-lying during labor is so prevalent you could easily assume it’s the most beneficial position for birth. Would it surprise you to know that it isn’t?
Here are 3 reasons to avoid back-lying during your labor and birth:
- It reduces the pelvic outlet. The baby must move through your pelvis during birth, so you’ll want to maximize not reduce its dimensions. Lying on your back compresses your pelvis, pushing your sacrum and coccyx (the back of your pelvis and your tailbone) inward, reducing your pelvic outlet and encroaching on the space your baby needs. When you get off your back, your pelvis can open to its maximal position. This is an effective way to give your baby more space, which leads to more ease for your labor and birth. Research shows it also shortens labor.[i]
- It works against gravity. Back-lying with your legs in stirrups or holding your own legs up can cause unnecessary strain. Have you heard of “purple pushing?” That’s when your race flushes purple with strain, usually due to overexertion, breath holding or directed pushing, and it’s not a necessary part of labor. It’s common during back-lying birth. In lithotomy position you’re not using gravity to your advantage to assist your birth process. Gravity is neutral when you’re on your back, so it’s not helping you get your baby down and out. Worse, gravity can work against you when you’re in lithotomy position and you’re directed to grab your legs and pull them towards your ears. This rotates your pelvis up, and baby has to then move uphill to be born. (watch my demonstration). Moving downhill with gravity is certainly easier than moving uphill against gravity. To harness gravity and use it to help your birth, get up on your feet.
- It isn’t comfortable. Most women find back-lying during labor intolerable, which is one reason epidural use is common. The baby’s head presses on your sacrum and it can feel painful when you then lie down on your back and sacrum. The lack of mobility can also cause discomfort. Getting up and moving around during labor opens up new possibilities for comfort and ease. This isn’t possible with an epidural, so if it’s your desire to get up and dance, move, walk or stand, let your birth team know beforehand and start discussing how they’ll support you. 99% of women who were upright during birth say they’d make the same choice again.[ii]
Ever wonder how back-lying birth got started in the first place? Back-lying birth is so common it may seem like it’s always been done this way, but it hasn’t. King Louis XIV of France wanted to see his mistress give birth. This was in the 1600’s and men weren’t normally present at births in those days. He couldn’t see much because women gave birth uprightly then, wearing long skirts, so she gave birth on her back with her legs open. Around this same time obstetrics and episiotomy originated.
It persists, in part, because this is how many birth professionals are taught to catch babies. The expectation is that the woman must be in the bed on her back with her legs open when the baby is coming. Both the bed and the professional’s stool are raised or lowered for the professional’s comfort. Unacceptably, women are sometimes forcibly restricted to lie on their backs when they don’t want to. However, comprehensive education and continuing education of birth professionals should include instruction and practice in providing support for laboring and birthing out of bed, and catching a baby in any position the birthing person is comfortable in. It also needs to emphasize women’s right to autonomy during birth. When you’re interviewing midwives or doctors to attend your birth, be sure to learn about their level of experience and confidence with the labor and birth positions you are considering.
Worried about getting tired? Avoiding back-lying during your labor and birth doesn’t mean you won’t rest when you’re tired. There are lots of ways to rest without lying on your back, and lots of ways to be upright without fully supporting your own weight yourself. Start exploring and practicing now, on your own or with support people. Staying active during pregnancy is a great way to build your stamina to be up on your feet during your birth.
You’re the number one expert on your body, your baby and your birth! Your best birth position will always be the one that feels right to you in the moment.
What’s your viewpoint? Share in the comments!
Stephanie Larson is a leading world expert on supporting pregnancy, birth and new parenthood through movement and instinct. She is the Founder and Master Trainer of Dancing For Birth™ the global pre/post natal class. Larson calls for an end to forced lithotomy position, and a worldwide shift to primal, powerful, euphoric birth and conscious parenting. Her speaking engagements and TV appearances include DONA International, Lamaze International, CAPPA, ICAN, CIMS, ICEA, CAPPA Canada, AWHONN, CBS, NBC and FOX. She ‘danced out’ her four babies in birth center, hospital and home births.