Birthing Positions

By Miral Patel

Do you recall what position you, your mom or your friends gave birth in?  Was it lying on their back?  That's likely the case.  94% of women in Canada deliver their baby while lying on their back.  This is in fact the worst position to be in for giving birth. 

Let's take gravity into consideration. Lying flat on your back takes away the role of gravity, which can help to bring the baby down. In labour, when a woman is upright she has gravity working on her side. Pretty straight-forward right?

Next we consider mobility of the pelvis. The path your baby goes through during delivery is made up of 3 bones. Two innominate bones and the sacrum.  (insert diagram of pelvis) These bones connect via muscles, ligaments, and cartilage to create the birth canal.  One may think the pelvis is a sturdy fixed structure, however the pelvis can move quite a bit.  Movement between the 3 bones that make up the birth canal allows for opening of the birth canal as your baby passes through.  Lying flat on your back fixes the bones in your pelvis and prevents any movement when the baby comes through.  Also, lying flat on your back can compress the main vein that takes blood back to the heart.  This compromise in blood flow can make mom feel light headed, as well as make the contractions less effective. 

With gravity and pelvic mobility in mind, let’s consider positions that are actually favourable during birth!

During Active Labour:

Standing and Walking: With standing and walking, we have gravity on our side helping bring baby down.  Furthermore, your pelvis is not fixed against a hard surface.  Standing and walking can help make mom feel like she's still in control.  During contractions she can lean against a wall or against her partner.  Another position that works well in standing is holding onto the hand rail in hospital hallways and leaning forward.  Some compression of your pelvis in this position can also help ease the pain during contractions. 

4 point kneeling:  For some moms they may find being on all fours and rocking forward and back or side-to-side works well for them.  In this case, we still have pelvic mobility and a little bit of gravity assisting us.  During contractions mom may be most comfortable bringing her bum down between wide heels and resting her upper body on the bed/floor. 

Ball Rocking:  Another good position during early labour is sitting on an exercise ball and rocking front-to-back and side-to-side.  Once again you have gravity on your side and the rocking helps open up the pelvis in various areas.  In early labour mom may be okay to sit on the ball independently and rock back and forth.  Later in labour when contractions become stronger, mom may require some extra help from her partner to hug (in front) or lean against.

Backwards sitting:  Some moms may be unable to stay upright and walk around during labour, in this case sitting backwards on a chair may work well for them.  Mom should be straddling the chair seat between her legs and leaning with her stomach/shoulders/head against the back rest of the chair.  Placing a pillow between mom’s stomach and the chair and using another pillow to rest mom’s head may also be comforting.

During Pushing:

Side-lying: If you are giving birth at home or in a birth center your midwife may be open to a variety of positions.  In hospital, due to liability issues as well as the effects of medications like the epidural, you may be limited to just a few positions.  Side-lying is a good alternative to lying on your back especially when in a hospital or if you've had the epidural.  Lying on either side works, however the left side is optimal.  You can start with a pillow between your knees but eventually your partner or the nurse will have to help by holding your top leg up during pushing. 

Squatting:  Squatting has an added advantage as it helps open up the outlet to your pelvis or your birthing canal.  This gives your baby more wiggle room so he/she can come out with ease.  Squatting can be done with a hospital bed if there is a squatting bar.  Many labour wards will have hospital beds with a squatting bar anchored to the foot of the bed.  Mom can use the bar for support as she squats.  She can also try hand hold squatting where she hangs onto her partner’s hands as she squats down.

Lying on your Back:  This is the least favourable position to deliver in, however, many women for one reason or another end up on their backs. Rather than lying flat on your back it's advisable to boost yourself up with some towels. Roll up 2 bath towels into 3-4 inch rolls and put elastics on them so they don't come apart.  If you do end up pushing on your back, place the two towel rolls under your pelvis so that you're not completely fixing the pelvis against the bed.  The space created by the towels will allow for some movement of the pelvis.

If you think some of these positions may work for you, be sure to practice them with your partner before birth.  Coming to see a pelvic floor physiotherapist at Physio Excellence may also be useful, as our therapists are specially trained in labour and delivery.  They will be able to assist with preparing your pelvic floor before delivery.  They can also walk you and your partner through the many birthing positions that are available to you.