The use of the lithotomy (the “on the back” or supine) birth position is declining in industrialized nations around the world, except in the United States. (2)

More than 57 percent of women who gave birth vaginally reported that they lay on their backs while pushing their baby out. (1) Semi-sitting accounts for about 65.9 percent of vaginal deliveries.

The main reason for the use of this position is convenience — it makes it easy for doctors and nurses to tend to the mother and to the baby.

However, there is an increasing amount of evidence that this is the worst birthing position.

Why Position Matters in Childbirth

Moving around and laboring in other positions (i.e., kneeling, walking) can:

• Speed up labor

• Make contractions more effective

• Facilitate better widening of the cervix

• Reduce back pain and pain during pushing

• Reduce the risk of perineal tears

The Dangers of Lithotomy Position in Childbirth

The lithotomy childbirth position has been shown to result in:

• More painful and less effective contractions – “Being in the supine position ... during labor increases the possibility of back labor and can make it much more painful.” (4)

• Longer labor times – One Latin American study showed that labors for first-time mothers who stayed upright were 36 percent shorter and 25 percent shorter for mothers who had previously given birth. (5)

• Reduced blood flow to the baby – The weight of the uterus compresses the blood vessels that supply or drain blood from your lower body. This compression decreases your blood pressure, compromises blood flow to the baby, and lowers the baby’s heart rate. It decreases baby’s oxygen saturation levels by up to 91 percent. It can also result in cord compression, increased risk of shoulder dystocia, and prolonged pushing stage. (1, 5)

• Narrower pelvic opening –The supine position puts direct pressure on the tailbone which flexes upward into a curved position, restricting the pelvic opening by up to 30 percent. (1)

• Pushing uphill – The lithotomy position places the birth canal essentially "uphill", forcing the mother to press upward against gravity to push the baby out. (1)

• Symphysis pubic dysfunction – The act of holding a woman’s legs back, particularly where unequal force is applied to either leg, can force the sides of the pelvis apart which can result in prolonged postpartum supra-pubic pain and other complications, such as difficulty walking. (1)

• Increased chances for tearing or need for episiotomy or use of forceps of vacuum extractions. (1)

Remember, you have the right to choose the birthing position you would like. The idea behind changing your body position is to help you take advantage of what your body’s designed to do naturally. Discuss the options with your obstetrician, family doctor and/or midwife.

Sources:

1) Best Labor and Birth Positions. GivingBirthNaturally.com. Web. Nov 15, 2012.
http://www.givingbirthnaturally.com/birth-positions.html

2) The Ineffective Lithotomy Position. GivingBirthNaturally.com. Web. Nov 15, 2012.
http://www.givingbirthnaturally.com/lithotomy.html

3) Positions for labour. BabyCentre. Web. Apr 23, 2012.
http://www.babycentre.co.uk/pregnancy/labourandbirth/labour/positions/

4) Back Labor. American Pregnancy Association. Web. Apr 23, 2012.
http://www.americanpregnancy.org/labornbirth/backlabor.html

5) “Easing Labor Pain: the complete guide to a more comfortable and rewarding birth” Lieberman, Adrienne. Child Development Institute Parenting Today. Web. Apr 23, 2012.
http://childdevelopmentinfo.com/child-teen-health/easing_labor_pain.shtml

Reviewed November 16, 2012
by MIchele Blacksberg RN
Edited by Jody Smith