Most of us are aware of women giving birth on their backs (known as the lithotomy position) or in a semi-sitting position (with the back of the bed tilted upwards so the woman is basically sitting up).
While there are advantages to the semi-sitting position, the traditional “on the back” position has several distinct disadvantages including compressing all major blood vessels consequently increasing maternal blood pressure, and reducing oxygen saturation levels in babies by up to 91 percent among other things. (4)
There are many other birthing positions that offer significant advantages to both mother and baby.
Standing, Walking and Sitting Birthing Positions
Standing - This position provides good oxygen levels for the baby and takes advantage of gravity, resulting in more effective contractions. (1)
If your labor is progressing slowly — such as with a brow presentation (see < a href= http://www.homebirth.net.au/2008/06/millas-birth-brow-presentation.html>Milla’s birth story) — standing can help move it along. Standing also results in a good urge to push.
Obvious disadvantages are that delivery is difficult to control, it is difficult for the doctor, midwife or nurse to see what’s going on, and there are concerns that the placenta can tear away from the uterus too quickly. (1, 4)
Walking - Walking during labor can reduce the pain of contractions, allows the contracting muscles to work more efficiently, and keeps the baby ideally aligned in the pelvis. Walking can help labor progress and reduce backache. Those with high blood pressure may not be able walk if continuous monitoring is required. (1, 2)
Sitting (Chair or Toilet) - Sitting, like standing and walking, makes use of the force of gravity in helping the progress of the baby through the birth canal.
A birth ball can also be used. A birthing chair allows a mother to rest where her back, hips and thighs are supported. Sitting may not be an option for women with high blood pressure.
Side Lying and Leaning/Kneeling
Side Lying - This position provides improved oxygen supply to the baby and a resting position for the mother. Lying on your side after an epidural makes contractions more effective, and it is safe for those with high blood pressure. It allows the baby to move easier along the base of the spine and tailbone. (1, 2)
It is probably the best position to avoid an episiotomy and tears. (3)
Leaning/Kneeling - Leaning forward, whether over a birthing ball, against the bed or back of a chair, may help turn a forward-facing (posterior position) baby. Leaning makes full use of gravity, makes contractions more productive and less painful, relieves back pressure, and allows the mother to rest.
Kneeling can also help turn a baby who is in a posterior presentation. Kneeling allows a mother to rock as well, which alleviates pain and helps the mother focus during contractions.(1, 2)
Squatting, and Hands and Knees
Squatting - This position takes advantage of gravity and encourages the baby to turn. The mother can alleviate pain and rest by shifting her weight. It allows excellent fetal circulation and actually increases “pelvic diameter by as much as two centimeters.” (2)
The position of the mother’s thighs keeps the baby where he/she needs to be, and pushing requires less effort on the part of the mother. The main disadvantage is that it can be tiring for the mother.
Hands and Knees - This is the ideal birthing position if there are low heart tones. This position relieves back labor and can help rotate a baby from a posterior presentation. This position is the “best position to avoid laceration or need for episiotomies.” (2)
This is the best position for birthing larger babies, or where a baby’s shoulder may get stuck after the head passes (shoulder dystocia) and for breech babies. (2, 5)
Sources:
1) Positions for Labor. Mother’s Advocate. Web. Nov 7, 2012.
http://www.lamaze.org/LaborPositions
2) Birthing Positions. Pregnancy.org. Web. Nov 7, 2012.
http://www.pregnancy.org/article/birthing-positions
3) Effective Birthing Positions. University of Minnesota. Web. Nov 7, 2012.
http://takingcharge.csh.umn.edu/activities/effective-birthing-positions
4) Best Labor and Birth Positions. GivingBirthNaturally.com. Nov 7, 2012.
http://www.givingbirthnaturally.com/birth-positions.html
5) “Hands off that breech!” Cronk, Mary. AIMS Journal, 2005, Vol 17 No 1.
http://www.aims.org.uk/Journal/Vol17No1/handsOff.htm
Reviewed November 7, 2012
by Michele Blacksberg RN
Edited by Jody Smith