Childbirth positions (or maternal birthing positions) are the physical postures that the pregnant mother may assume during the process of

childbirth Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy, where one or more Fetus, fetuses exits the Womb, internal environment of the mother via vaginal delivery or caesarean section and becomes a newborn to ...

. They may also be referred to as delivery positions or labor positions. In addition to the

lithotomy position The lithotomy position is a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations. The lithotomy position involves the positioning of ...

(on back with feet pulled up), still commonly used by many

obstetricians Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgic ...

, other positions are successfully used by

midwives A midwife (: midwives) is a health professional who cares for mothers and newborns around childbirth, a specialisation known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their ...

and traditional birth-attendants around the world. Engelmann's seminal 1882 work "Labor among primitive peoples" publicised the childbirth positions amongst primitive cultures to the Western world. They frequently use

squatting Squatting is the action of occupying an abandoned or unoccupied area of land or a building (usually residential) that the squatter does not own, rent or otherwise have lawful permission to use. The United Nations estimated in 2003 that there wer ...

standing Standing, also referred to as orthostasis, is a position in which the body is held in an upright (orthostatic) position and supported only by the feet. Although seemingly static, the body rocks slightly back and forth from the ankle in the ...

kneeling Kneeling is a basic human position where one or both knees touch the ground. According to Merriam-Webster, kneeling is defined as "to position the body so that one or both knees rest on the floor". Kneeling with only one knee, and not both, is ca ...

and all fours positions, often in a sequence. They are referred to as ''upright birth positions''. Understanding the physical effects of each birthing position on the mother and baby is important. However, the psychological effects are crucial as well. Knowledge about birthing positions can help mothers choose the option they are most comfortable with. Having the agency and self-control to change positions in labor positively influences the mother's comfort and birthing experience, which increases the birthing outcome and her satisfaction with labor.

Lithotomy position

In the lithotomy position, the birthing person is lying on their back with their legs up in stirrups and their buttocks close to the edge of the table. This position is convenient for the caregiver because it permits them more access to the

perineum The perineum (: perineums or perinea) in placentalia, placental mammals is the space between the anus and the genitals. The human perineum is between the anus and scrotum in the male or between the anus and vulva in the female. The perineum is ...

. The position has been largely popular in the US and other Western countries over the last two centuries, though cross-culturally and historically, it is very rare (about 18%) for people to assume a prone or dorsal position during childbirth. Reclining positions became common in France during the 17th century, as obstetrics became a more respected field and ideas of birth being an affliction rather than natural became widespread. The standard of women lying flat on their back originated in the early 19th century in the US, and was recommended by male obstetricians on the basis of claims that the position was both more convenient for attending medical staff and that women would be more comfortable lying on their backs. However, the lithotomy is not a comfortable position for most patients, considering the pressure on the vaginal walls because the baby's head is uneven and the labor process is working against gravity. Research suggests that maternal bodily positions have a notable influence on pain experienced during labor and delivery, and that positions such as squatting show significantly reduced pain compared to the lithotomy position.

Upright birth positions in general

Various people have promoted the adoption of upright birthing positions, particularly squatting, for Western countries, such as

Grantly Dick-Read Grantly Dick-Read (26 January 1890 – 11 June 1959) was a British obstetrician and a leading advocate of natural childbirth. Early life and education Dr. Grantly Dick-Read was born in Beccles, Suffolk on 26 January 1890, the son of a Norfolk ...

, Janet Balaskas, Moysés Paciornik and Hugo Sabatino. The adoption of the non-lithotomy positions is also promoted by the

natural childbirth Natural childbirth is childbirth without routine medical interventions, particularly anesthesia. Natural childbirth re-emerged in opposition to the medical model of childbirth that is common in industrialized societies. Natural childbirth attempts ...

movement. Being upright during labour and birth can increase the available space within the pelvis by 28–30% giving more room to the baby for rotation and descent. There is also a 54% decreased incidence of foetal heart rate abnormalities when the mother is upright. These birthing positions can also reduce the duration of the second stage of labour as well as reduce the risk for emergency

caesarian section Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would ...

s by 29%. They are also associated with the lower need for

epidural Epidural administration (from Ancient Greek ἐπί, "upon" + '' dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians ...

. Different positions may be associated with different rates of perineal injury.

Squatting position

The squatting position gives a greater increase of pressure in the pelvic cavity with minimal muscular effort. The birth canal will open 20 to 30% more in a squat than in any other position. It is recommended for the second stage of childbirth.Russell JG. Moulding of the pelvic outlet. J Obstet Gynaecol Br Commonw 1969;76:817–20. As most Western adults find it difficult to squat with heels down, compromises are often made such as putting a support under the elevated heels or another person supporting the squatter. In

ancient Egypt Ancient Egypt () was a cradle of civilization concentrated along the lower reaches of the Nile River in Northeast Africa. It emerged from prehistoric Egypt around 3150BC (according to conventional Egyptian chronology), when Upper and Lower E ...

, women delivered babies while squatting on a pair of

brick A brick is a type of construction material used to build walls, pavements and other elements in masonry construction. Properly, the term ''brick'' denotes a unit primarily composed of clay. But is now also used informally to denote building un ...

s, known as ''birth bricks''.

All-fours

Some mothers may choose the all-fours position instinctively. It can help the baby turn around in the case of a malpresentation of the head. Since this position uses gravity, it decreases back pain, as the mother is able to tilt her hips.

Side lying

Side lying may help slow the baby's descent down the birth canal, thereby giving the perineum more time to naturally stretch. To assume this position, the mother lies on her side with her knees bent. To push, a slight rolling movement is used such that the mother is propped up on one elbow is needed, while one leg is held up. This position does not use gravity but still holds an advantage over the lithotomy position, as it does not position the

venae cavae In anatomy, the ''venae cavae'' (; ''vena cava'' ; ) are two large veins (great vessels) that return deoxygenated blood from the body into the heart. In humans they are the superior vena cava and the inferior vena cava, and both empty into the ...

under the

uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...

, which decreases blood flow to mother and child.

References