Just about every movie with a birth scene has the birthing person on their back in the hospital bed. And while it’s true that this position makes it easy for care providers—doctors or midwives—to see things clearly as you push your baby out, it also might not be the best choice in terms of the birthing person’s experience. It’s also interesting that this is such a common experience for birthing people, because many care providers advise you NOT to lie on your back for extended periods of time during pregnancy to preserve blood flow to the uterus. If you’re pregnant, you’ve probably thought a lot about how you’ll give birth, so read on to learn the evidence behind giving birth in different positions and ideas for maximizing body positioning and gravity to get your baby out.
In a study published in 2014 in the American Journal of Obstetrics and Gynecology, Anke Reitter, a maternal-fetal medicine physician, and colleagues used magnetic resonance imaging to measure the openings of the pelvises of 50 pregnant and 50 non-pregnant women, while the subjects were either laying on their backs or in a kneeling squat position. They found that the squat increased pelvic dimensions by one to two centimeters over the supine position in both pregnant and non-pregnant women, which suggests that there might be more room for a baby to move through the pelvis if the birthing person is in an upright position.
Midwife Malin Edqvist and colleagues compared outcomes in nearly 3,000 women who birthed at home in four different countries in a study that was published in BMC Pregnancy and Childbirth in 2016. The researchers found that birthing positions in which the sacrum or tailbone could be more flexible—including squatting, kneeling, standing, all fours, side-lying, and sitting on a birth stool—were associated with fewer episiotomies. In their study, most women—who because they mostly birthed at home had a lot of freedom to move—chose a flexible sacrum position.
Rebecca Dekker, a nurse researcher and the founder of the website Evidence Based Birth, points out in an excellent Evidence Based Birth overview of the research on birth positioning that the benefits of an upright birthing position for birthing people who receive epidurals is less clear. For birthing people who haven’t had an epidural, though, there are benefits for both the fetus, including lower risk of abnormal heart rate, and the birthing person, including less pain and shorter pushing duration.
If you’d like to birth in an upright or flexible sacrum position and are planning to give birth in the hospital, talk to your care provider about what your options are. If you take a hospital tour (even a virtual one), ask the person giving the tour about whether there are birth stools or squat bars available. Ask to see how much you can move the bed to get it more upright, which may be a good option if you have an epidural or are attached to monitors or IVs that do not allow you to move off the bed. Sometimes there are squat bars that are available to use while you are in the bed or your nurse will help you find an extra sheet that you can loop over the door and use to support you while squatting. You can also kneel on the bed, lean over it, or raise the bed up really high and use it to hang onto as you squat.
Depending upon how long pushing takes, you may choose to rotate through several pushing positions. As much as you can, tune into the sensations in your body and try to work with what’s already happening. If that means you feel like getting on hands and knees or rolling over on your side—do it! Your nurse, birth partner, and doula if you have one can also be helpful in guiding you to try positions that might work well throughout labor, but especially during the pushing stage. Regardless of what they suggest, you’re the boss of your own body. “The bottom line is that people giving birth with or without an epidural have the right to push and give birth in whatever position is most comfortable for them,” Dekker writes at Evidence Based Birth.