Birth Positions – Why Birthing Upright Can Provide More Space For Your Baby

When most people think of a woman giving birth, they think of what they see in the movies:

…. Women lying on their backs

…. Screaming in agony

… Monitors ticking away

… With a room full of nurses and doctors around watching

…She is always in a hospital gown with her makeup and hair done but kind of messy

This month I want to tackle a topic that may be known by some but not by many – what is the best position to birth in and why this is important for you to know?

Simply put there are two main ways: upright or non-upright.

To date, the majority of US women, 57%, give birth lying on their back and 35% are in a semi-sitting/lying position with the head of the bed raised. This accounts for 92%, while only 4% are side lying, 3% sit or squat and 1% are in a hands-knees position (Declercq, Sakala et al. 2007).

Most women are encouraged to push in a lying or semi-sitting position because it is a lot easier for the care provider (maybe the movies are accurate?!). They can access the women’s abdomen to monitor fetal heart rate (…the constant monitor ticking…). This is how most care providers are taught to attend births, so it makes sense that it is the position they would want moms in.

But what about an upright position?

Why is pushing in an upright position beneficial?

Well first, gravity is your friend and will help pull the baby down towards earth. There is also less risk of compressing the moms aorta and thus better oxygen supply to the baby. (Have you ever though about how women are told to only lay on their side when pregnant but all of a sudden it is different during labour?) Upright positioning also helps the uterus contract more strongly and efficiently while helping the baby get in a better position to pass through the pelvis.

X-ray evidence has also shown that the actual dimension of the pelvic outlet becomes wider during squatting or kneeling/hands-knees positions – up to 4 cm bigger! Yes please! (Gupta et al. 2012). This is because any position that denies postural sacral rotation denies mom and the baby critical pelvic outlet diameter by moving the tip of the sacrum up into the pelvic outlet.

In 2012, a Cochrane review found that women who were randomly assigned to upright positions during birth who did not have an epidural were:

• 23% less likely to have forceps or vacuum-assisted delivery
• 21% less likely to have an episiotomy
• 35% more likely to have a second degree tear
• 54% less likely to have abnormal fetal heart rate patterns
• 65% more likely to have blood loss greater than 500 mL

Lets looks at theses stats a little closer…

Less forceps, vacuum-extraction, episiotomy and abnormal fetal heart rate patterns sounds great BUT what about increased tears and blood loss?

Many researchers and doctors have found that tears are easier to heal and less traumatic to tissue than episiotomies so this actually may be a good trade off (Carroli and Mignini 2009). Secondly, blood loss rates are usually based on an estimate by the care provider so it isn’t exactly accurate. There was no difference in the need for blood transfusions between groups so the blood loss wasn’t serious enough to have to add more.

Interesting!

 Now what about women who choose to have an epidural?

In the US, 71% of women choose to have an epidural. Although there hasn’t been a ton of research completed, evidence suggests that women with walking epidurals are capable of mobilizing during the second stage of labour and that women who are upright (+ epidural) are more likely to have a shorter labour and pushing phase. With traditional epidurals, there have been no studies comparing upright and non-upright positions.

Really, the most important thing about birthing position is to listen to your body and your baby.

Prior to Lyla’s birth, I had envisioned birthing in a squatting position or on hands and knees but to be honest, after 18 hours of labouring in those positions, I was tired and she was positioned posterior. The best position for me was on my back, curled into a ball with my knees up at my head…. And then finally on my back in my bed was how she was birthed… Very different from the plan! BUT I had to listen to my body and my midwifes and together we made it happen.

You also don’t have to be continuously in one position – switch it up based on what is feeling “right”.

A great place to get more research when it comes to birth is Evidence Based Birth at https://evidencebasedbirth.com. I would highly suggest following their work!

If you have any questions or want more resources, feel free to contact me.

Dr Sarah

References:

1. Carroli, G. and L. Mignini (2009). “Episiotomy for vaginal birth.” Cochrane Database Syst Rev(1): CD000081.

2. Declercq, E. R., C. Sakala, et al. (2007). “Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International.” J Perinat Educ 16(4): 15-17.

3. Gupta, J. K., G. J. Hofmeyr, et al. (2012). “Position in the second stage of labour for women without epidural anaesthesia.” Cochrane Database Syst Rev 5: CD002006.

4. https://evidencebasedbirth.com/what-is-the-evidence-for-pushing-positions/