Positions for Labour and Delivery

Currently in North America, the majority of birthing parents who deliver their babies vaginally do so laying on their backs or in a semi-reclined position.  As well as being the most common, it’s also the most represented in media like TV shows and movies.  As such, many people may assume that this is the only position for labour and delivery, because it’s the only one they’ve ever seen or heard of!  However, there are actually several alternate positions that can be used during labour and delivery and there are some benefits that can make them more desirable choices. 

Firstly, let’s look at some of the potential issues with the most common birthing positions.  Due to the anatomy of the pelvis and the birth canal, when positioned on their back a birthing parent has to essentially push “up hill” or against gravity.  In this situation, a lot of pressure is directed towards the back vaginal wall and can contribute to vaginal tissue or perineal tearing.  Additionally, the tailbone is blocked from movement, reducing the extent to which the pelvic outlet can open, allowing for baby to pass through.  However, being in a back laying position may be preferable for both the use of epidurals and electronic fetal heart rate monitors.

There are some known benefits to positions for labour and delivery that are considered to be “upright”, such as supported standing, squatting, kneeling, or sitting on a birth chair.  In these positions, gravity assists the baby’s movement through the birth canal. Additionally, when in an upright position it is thought that the uterus can contract more efficiently and strongly, aiding in progression of delivery.  Also, in these positions the tailbone is free to extend and allow for the maximum amount of expansion of the pelvis. Research has also shown that those who assume an upright position for the second stage of labour are less likely to have a forceps or vacuum assisted birth, or need an episiotomy.  The Society of Obstetricians and Gynaecologists of Canada state in their guidelines for management of spontaneous labour in healthy women that “women should be informed of the benefits of upright positioning in labour and encouraged and assisted to assume whatever positions they find most comfortable.

There are certain positions that may be beneficial or more comfortable for individuals who may have pre-existing conditions, or have experienced musculoskeletal pelvic or low back pain during their pregnancy.  For those with sacroiliac joint (SIJ) or pubic symphysis (pubic bone) pain or dysfunction, upright positions like hands and knees, upright kneeling, or using a birthing ball are recommended. For those with tailbone pain, any position where the tailbone is free to move (squatting, hands and knees, upright on knees, standing, or side-lying) is recommended.  Laying on the back with the hips flexed up and externally rotated (lithotomy position) is not recommended for people with any of these pelvic or low back pain conditions.

It’s clear that when it comes to positioning for labour and delivery, there are many factors to be considered and it’s a complex issue.  The optimal situation for each individual is one that includes them being educated and informed on all the potential positions along with their pros and cons, and should take their comfort and any pre-existing conditions into consideration.  A pelvic health physiotherapist can help you to learn about, understand, and practise different birthing positions, and provide guidance for you to continue your own research.

If you would like to learn more about how to best prepare for birth, sign up for a FREE ‘Practical Birth Preparation’ Video Series here.

 

Resources:
https://evidencebasedbirth.com/evidence-birthing-positions/

-Management of Spontaneous Labour and Term in Health Women, L. Lee, J. Dy, H. Hussam. SOGC Clinic Practise Guideline, Journal of Obstetrics and Gynaecology Canada. https://www.jogc.com/article/S1701-2163(16)39222-2/pdf

-https://www.pregnancybirthbaby.org.au/positions-for-labour-and-birth

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