In America if we give birth in the hospital we generally get one option of how to position ourselves to have a baby: lying on our back on the table with our legs up. This is fine for a lot of women, and I’m sure it is easiest on the doctors, which is probably why they have us giving birth in this position. But what if this isn’t the best position for your body to give birth? Is there something better? Do we have other options? The answer is yes, we have nearly a dozen birthing positions to choose from and every woman may have a different position that works best for her.
The different positions for labor and delivery are:
Supine (lying flat on your back)
Lithotomy (how hospitals generally position women, the position we get pelvic exams in)
McRobert’s (knees fully flexed to your chest)
Squatting between partner’s knees
Hands and knees (all 4’s)
Modified plantigrade (leaning forward onto table with elbows)
Semi-fowler (lying on your back with head of bed up 30-45*)
The goal with these different positions is to find which is best for your body. Certain positions are going to open up your pelvic floor better which will make for an easier delivery with less tearing and hopefully no episiotomies (cutting of your pelvic tissues to make room for the baby to come out). Semi-Fowler’s position and sidelying are generally the two best positions for American women to give birth. In these positions women are able to relax their pelvic floor muscles to allow for easier opening of the vagina for delivery. Squatting is generally not a very efficient posture for American women because we do not squat enough in our culture to be able to sustain this position and relax our pelvic floor muscles. In other cultures, this position is used often for birthing and is very efficient. Squatting and upright postures allow for gravity to assist in the birthing process, however if a woman is not comfortable squatting she may be contracting her pelvic floor muscles instead of letting them relax and open up, which would be counter-productive.
Let’s go over a few pro’s and con’s of each position. First is supine, or lying flat on your back. Most women are very comfortable in this position. This is how we sleep, lying down flat. We are used to this position. However, we are not letting gravity assist us in this position and the pelvic outlet is not fully opened in this position.
Lithotomy is a common birthing position in American culture. Women are used to this position from getting pelvic exams at the doctor’s office. This position with our legs bent up and apart as well as being supported by stirrups is a good position to open up the vagina and pelvic outlet. Similar to the supine position, we are not letting gravity assist the birthing process too much.
McRobert’s position is better and is used frequently in the second stage of labor (the pushing phase). In this position the woman’s knees are flexed all the way where she is hugging them to her chest. This opens up the pelvic outlet nicely. According to Buhimschi, et al. (Lancet 2001 Aug 11; 358 (9280):470-1) the use of McRoberts' position almost doubled the intrauterine pressure developed by contractions alone (from 1653 mm Hg s to 3262 mm Hg). This position is used to facilitate delivery of the fetal shoulders. It is effective due to the increased mobility at the sacroiliac joint during pregnancy, allowing rotation of the pelvis and facilitating the release of the fetal shoulder.
The birthing chair has been used for centuries in many cultures, dating all the way back to ancient Greek and Egyptian cultures. It has recently made a return to the birthing scene around the 1980’s. Some expecting mothers have reverted to the birthing chair for its upright position because it allows gravity to assist in the expulsion of the baby. Studies have shown that the birthing chair speeds up the time of delivery and increases comfort for expecting mothers. The position of the birthing chair allows muscles (including vaginal and abdominal as well as those in the back, stomach, legs, and arms) used in childbirth to work to efficiently. 3 The Kaya Stool (kayabirth.com) is a common birthing stool or chair used today. It is a nice option because you can use it to sit or for the modified plantigrade position.
Squatting is generally not the best position for most American women due to lack of practice in this position. It can be a good position if the woman is comfortable in this position and her legs are strong enough to endure squatting because it can open up the pelvic outlet nicely, however if the woman is uncomfortable or fatigued and straining to maintain this position she is going to tighten up her pelvic floor and the position will be counterproductive. Also, if the woman has had an epidural she may be unable to tolerate squatting, so check with your doctor or midwife who is assisting in the delivery. It is recommended that a woman practice squatting for 6 months prior to delivery if this is the position she wants to deliver in.4 Squatting between a partner’s knees or with support may be a better option for many American women.
Giving birth on hands and knees, or all fours, is another great option. This position also opens up the pelvic outlet nicely. Most American women can tolerate this position for longer periods of time than squatting. Gravity is helping and it may be a good position to relieve back pain and labor.
Kneeling is also another option that uses gravity assist. Again, most women can relax their pelvic floor muscles nicely in this position. The woman can also hold onto something for support while kneeling and change her position from low to high kneeling to rest her legs between contractions. Kneeling also can be a relief from back pain.
Modified plantigrade is where the woman is leaning forward with her hands or elbows on a table. This is a nice gravity assisted position but the woman also has the support of the table to help her. When she becomes fatigued she can lean much of her upper body onto the table for support.
Sidelying is one of the best positions for American women to give birth in. It is supported, relaxed and comfortable so the pelvic outlet can open wide for delivery. The top leg can be supported by pillows, stirrups, a ball, etc.
Semi-fowler positioning is also a common birthing position in America and one of the best for most American women. In this position a woman is lying on her back, but the head of the bed is raised 30-45 degrees so the woman has back support and some gravity assist. When the head of the bed is raised to 90 degrees it is called the Fowler’s position.
These are some of the different birthing position options. Each woman and each pregnancy may be different depending on the woman’s body, prior surgeries and injuries, fitness level, etc. The great thing is we can test out these different positions in the clinic and give the woman some suggestions for which position would be best for her body to give birth.
We test this by applying a few tiny electrodes to the external vagina. These electrodes pick up muscle signals and are attached to a machine called a biofeedback unit that shows us how relaxed or contracted the pelvic floor muscles are in each position. This test is painless. We then can tell which positions are going to be the easiest for that woman to deliver and are going to have less likelihood of tearing or needing an episiotomy.
If you would like to come in for this simple, painless test please call or email today and we can schedule an appointment. It may save you a lot of tearing and difficulty during childbirth as well as decrease the recovery time after delivery.
Dr. Carri Dominick, PT, CSCS
Gonik, B.; Stringer, C. A.; Held, B. (1983). "An alternate maneuver for management of shoulder dystocia". American Journal of Obstetrics and Gynecology. 145 (7): 882–884. PMID 6837666.
Jump up^ Gherman, R. B.; Tramont, J.; Muffley, P.; Goodwin, T. M. (2000). "Analysis of McRoberts' maneuver by x-ray pelvimetry". Obstetrics and gynecology. 95 (1): 43–47. doi:10.1016/s0029-7844(99)00445-7. PMID 10636500..
Pregnancy and Postpartum: Clinical Highlights; Hollis Herman; NYC Nov 15-16 2008.