3 Reasons to Avoid Back-lying During LaborJan 08, 2023
by Stephanie Larson
When you think of birth, what position jumps to mind? Is it the lithotomy position―the one where the birthing parent is lying on their back in bed with their legs up in stirrups? Or maybe it's the semi-recumbent position (lying back partially). Back-lying during labor is so prevalent you could easily assume it’s the most beneficial position for birth. Would it surprise you to know that it isn’t?
Here are 3 reasons to avoid back-lying during your labor and birth:
1. It reduces the size of the pelvic outlet. Your baby must move through your pelvis during birth, so you’ll want to maximize, not reduce, its dimensions. Lying on your back compresses your pelvis, pushing your sacrum and coccyx (the back of your pelvis and your tailbone) inward, reducing your pelvic outlet and encroaching on the space your baby needs. When you get off your back, your pelvis can open to its maximal position. This is an effective way to give your baby more space, which leads to more ease for your labor and birth. Research shows it shortens labor, reduces the risk of cesarean birth, and lessens epidural use.
2. It works against gravity. Back-lying during birth can cause unnecessary strain. Have you heard of “purple pushing?” That’s when your race flushes purple with strain, usually due to overexertion, breath holding, or directed pushing, and it’s not a necessary part of labor. It’s very common during back-lying birth, unfortunately. When you're on your back in bed, you’re not using gravity to your advantage to assist your birth process. Gravity is neutral when you’re lying down, so it’s not helping you move your baby down and out. Gravity actually works against you when you (or someone else) grabs your legs and pulls your knees towards your ears. This position rotates your pelvis upwards, and baby has to then move uphill to be born (watch my demonstration). Moving your baby downhill with gravity is certainly easier than moving them uphill against gravity. To harness gravity to your benefit and use it to help facilitate your birth, get up on your feet.
3. It isn’t comfortable. Most birthing individuals find back-lying during labor intolerable, which is one reason epidural use is so common. During labor your baby’s head presses on your sacrum and it can feel painful when you then lie down on your back (and your sacrum). The lack of mobility can also cause discomfort. Being out of bed and moving around during labor opens up new possibilities for comfort and ease. This isn’t possible with an epidural, so if it’s your desire to get up and dance, move, walk or stand, let your birth team know beforehand and start discussing how they’ll support you. 99% of parents who were upright during birth say they’d make the same choice again.
Ever wonder how back-lying birth got started in the first place? Back-lying birth is so common it may seem like it’s always been done this way, but it hasn’t. In the late 1600's French physician François Mariceau was influential in the shift from upright birthing to back-lying birthing, for the comfort of the physicians (not for the comfort of women). King Louis XIV of France purportedly benefitted from this change, because he wanted to see his wife and mistresses give birth. This was unusual because men weren’t normally present at births in those days. If the women had given birth uprightly, wearing their long skirts, he wouldn't have been able to see anything, so they birthed on their backs with their legs open. Around this same time, obstetrics and episiotomy originated.
It persists, in part, because this is how many healthcare providers are taught to catch babies. In hospital births, the expectation is usually that the birthing person must be in the bed on their back with their legs open when the baby is coming. The bed and the doctor's (or midwife's) stool are raised or lowered for the professional’s comfort, but little or no thought is given as to whether this birth position is comfortable for the person who is giving birth. Unacceptably, birthing women and individuals are sometimes forcibly restricted to be on their backs, against their objections. This is one form of obstetric violence. Reform is needed so that the training and continuing education of healthcare providers includes instruction and practice in providing support for labors and births that happen out of bed, and for catching a baby in any position the birthing person is comfortable in. It also must emphasize human rights and birth rights, such as autonomy during birth, and the right to birth-position of choice. When you’re interviewing midwives or doctors to attend your birth, be sure to learn about their level of experience and confidence with the labor and birth positions you might want to explore, and ask them to be specific about how they will support you to utilize these positions. Also carefully consider where you want to give birth, for example, hospital, birth center, free-standing birth center, or home.
Worried about getting tired? Avoiding back-lying during your labor and birth doesn’t mean you won’t rest when you’re tired. There are lots of ways to rest without lying on your back, and many ways to be upright without fully supporting your own weight all by yourself. Start exploring and practicing now, so you'll feel confident later. Staying active during pregnancy is a great way to build up your stamina, so you can be out of bed and on your feet during your birth.
You’re the number one expert on your body, your baby, and your birth. You know yourself and your baby better than anyone else does. Your best birth position will be the one that feels right to you, in the moment. So pay close attention to what your body and your baby are telling you, and follow your inherent birth instincts. You've got this!