Get Off My Back!

“(I need to) get off my back!” This should be the cry of many more laboring woman in America!

Why is it that so many women push their babies out lying on their backs with their legs spread wide and up in stirrups? This position, called the lithotomy position, is a doctor-introduced position for childbirth that makes it much easier for the birth attendant to see progress, have access to the perineal area, and catch the baby. It also makes it easier to perform certain interventions, such as episiotomies and maintaining electronic fetal monitoring. This definitely makes it more convenient for the birth attendant, but what does it do for the woman giving birth?

The lithotomy position puts the mother at a serious disadvantage. It makes her have to fight gravity and push her baby through a twisted tunnel. It also narrows the pelvic opening considerably, making it much harder for the baby to fit through. It can lower oxygen supply to the baby because of pressure on major blood vessels, and can also increase the need for episiotomy and likelihood of tears. This position makes the mother have to push harder and longer to get anywhere, so it puts unneeded strain both on the mother and her baby. Plus, it’s just plain humiliating to lay there spread wide for the whole world to see.

Being upright, however, creates more space for the baby to move down, gives the mom the aid of gravity, opens the pelvis, speeds the pushing stage, and usually causes less tears. This is much more mother and baby friendly, as it provides various benefits for the mother and gives the baby more oxygen and, usually, a shorter trip through the birth canal.

What exactly is an upright position? Well, it can be sitting upright in a bed, leaning against something or someone, standing, kneeling, squatting, semi-squatting, sitting on a birthing stool, or getting on hands and knees. All of these positions allow more space for the baby to move down and are more comfortable for the mother than the lithotomy position. Note that moving from position to position as desired also facilitates progress for the baby and comfort for the mother. My experience with childbirth was that if it felt comfortable for me, it was probably also the healthiest for me and my baby- “If it feels good, do it!”

My favorite quote regarding  positions for labor is from Roberto Caldeyro-Barcia. He stated, “Except for being hanged by the feet, the supine position is the worst conceivable position for labor and delivery.” 

Here are a couple of great resources on positions for birth:

Lithotomy Position for Labor– An excellent article from which I gleaned a lot of this information.

The Evil Lithotomy Position– Harsh title, but accurate evidence-based information.

Hope this is helpful!


One response to this post.

  1. […] Resources « Get Off My Back! […]


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