It is a common question to ask if you must deliver a baby while lying on your back, and the straightforward answer is no. Labor and delivery positions are dynamic and varied, offering choices that influence comfort and the birthing process itself. While many people associate childbirth with the image of lying flat in a hospital bed, this position is only one of many available options. Understanding the full range of possibilities gives you choice and control over your birthing experience.
The Tradition of Lying Down
The widespread practice of giving birth while lying on the back, known as the supine or lithotomy position, is a relatively recent phenomenon. This position gained popularity not because it offered physiological advantages, but largely for the convenience of the medical provider. The lithotomy position provides clear visibility and easy access to the perineum, which facilitates medical interventions like the use of forceps or continuous electronic fetal monitoring.
This shift toward the supine position coincided with the medicalization of birth and the increased involvement of physicians during the 17th and 18th centuries. The introduction of anesthesia in the mid-19th century further cemented the practice, as it rendered laboring people unable to move or change positions freely. Today, the semi-reclined position remains the default in many hospital settings because it accommodates the equipment and logistical needs of the care team.
Physiological Effects of Birth Positions
Lying flat on the back can create specific physiological challenges that alternative positions avoid. When a pregnant person lies supine, the heavy uterus can compress the inferior vena cava, a major vein returning blood to the heart. This aortocaval compression can reduce cardiac output, leading to hypotension (low blood pressure) and diminished blood flow to the placenta and the baby.
In contrast, upright positions use gravity to assist the baby’s descent through the birth canal, making contractions more efficient. The position of the pelvis is significantly affected by posture. When upright or squatting, the diameter of the pelvic outlet can increase by as much as 28 to 30%, providing more space for the baby to navigate the final stages of birth. This increased space and the aid of gravity can lead to a shorter second stage of labor and a reduced risk of needing an assisted vaginal delivery.
Exploring Alternative Positions
Many alternatives to the supine position are available during labor and delivery, each serving a specific purpose for comfort or fetal positioning. The hands-and-knees position, often called “all fours,” is effective for relieving severe back pain, known as back labor. This posture also helps encourage the baby to rotate if they are in a posterior position.
Squatting is the most mechanically advantageous position, as it maximally opens the pelvic outlet to accommodate the baby’s passage. Supported squatting using a birthing bar or stool harnesses gravity to aid in the final push, though it can be physically demanding. The side-lying or lateral position is an excellent option for resting during long labors or for those with an epidural. It prevents vena cava compression and can be used with a peanut ball placed between the legs to widen the pelvis. Walking, standing, and leaning forward are also helpful upright positions in early labor, allowing mobility and control.
Advocating for Your Position Preferences
To ensure your preference for an alternative position is respected, preparation begins well before labor starts. Create a comprehensive birth plan that explicitly states your desired positions for both laboring and pushing. Discussing this plan with your doctor or midwife during prenatal appointments is important to confirm their support.
You must also communicate with the nursing staff upon arrival at the hospital, as they will be assisting your movement during labor. While an epidural limits movement, positions like side-lying or supported semi-sitting remain possible and offer advantages over lying flat on the back. If a medical emergency arises or if continuous monitoring is necessary, your care team may require you to temporarily adopt a more restrictive position to ensure safety.