Why you Should Avoid the Supine Birthing Position

For centuries, women gave birth in a variety of gravity-based and/or pain-reducing birthing positions, usually assisted by female midwives. It wasn’t until male doctors started using forceps in the 17^th century, and further after the discovery of pain medications in the late 19^th and early 20^th centuries that a woman was instructed to labor and push on her back with her legs up in stirrups.

As our modern society looks to get back to more natural roots, more and more women are looking to return to those positions which most help our bodies give birth safely. Still, many more mothers aren’t even aware that they have a choice or what the risks are of certain birthing positions. While the popularity and preference for a semi-sitting position is growing, many hospitals still use the supine (on your back) birthing position. So, let’s take a brief look at why you should avoid this position.

What is the Supine Birthing Position?

The supine birthing position is also known as lithotomy. It is what we commonly see in the movies and on TV where the mother is lying flat on her back with her legs pulled back to either side. The majority of hospitals in the United States still use this position. “‘More than half (57 percent) of women who gave birth vaginally reported that they lay on their backs while pushing their baby out and giving birth …” (GivingBirthNaturally.com) Semi-sitting accounts for about 65.9 percent of vaginal deliveries, mainly because it is convenient for doctors and nurses as there is easy access to the mother.

However, there are several disadvantages and, actually, dangers to this position.

Why Position Matters in Childbirth

Evidence is now starting to show how detrimental and even dangerous lying on your back can be during childbirth. The goal of positioning during childbirth is to:

• Facilitate alignment of the baby’s body and head in preparation for passing through the birth canal

• Maximize intrauterine contractions resulting in better widening of the cervix

• Reduce pain and increase maternal comfort

• Maintain optimal fetal environment
  

The Dangers of Lithotomy Position in Childbirth

By stark contrast, the lithotomy childbirth position results in:

• More painful and less effective contractions – “Being in the supine position … during labor increases the possibility of back labor and can make it much more painful.” (American Pregnancy Association)

• Longer labor times – Likely due to the less effective contractions, “One famous Latin American study comparing reclining to vertical positions showed that labors for women who stayed upright were 36 percent shorter for first-time mothers and 25 percent shorter for mothers who had previously given birth.” (Lieberman)

• Reduced blood flow to the baby – “When you lie on your back for long periods of time, the weight of the uterus compresses the descending aorta and inferior vena cava, blood vessels that supply or drain the lower part of your body. This … reduces your blood pressure, compromising blood flow to your baby and causing his heart rate to drop.” (Lieberman) Interference with circulation also results in lower oxygen saturation levels in the baby by up to 91 percent, cord compression, increased risk of shoulder dystocia, and prolonged period of bearing down.

• Narrower pelvic opening – “[T]he pelvic outlet is up to 30% smaller” (GivingBirthNaturally.com) in this position. The supine position puts direct pressure on the tailbone, thereby, flexing it upward into a curved position and restricting the pelvic opening.

• Pushing uphill – In the lithotomic position, “[t]he birth canal is effectively placed in an ‘uphill’ orientation, forcing the mother to push upward against gravity to expel the baby.” (GivingBirthNaturally.com)

• Symphysis pubic dysfunction – The act of holding a woman’s legs back, particularly where unequal force is applied to either leg, can force the sides of the pelvis apart. The pubic symphysis is where the two sides of the pelvis meet at the groin. (GivingBirthNaturally.com) Forcing these two sides apart can result in prolonged postpartum supra-pubic pain, and other complications such as difficulty walking. Symphysis pubic dysfunction is a particular concern in women who have epidurals.

• Increased chances for tearing or need for episiotomy – Lithotomy puts pressure on the perineum, a part of the body between the vagina and the rectum, potentially resulting in tearing or the need for an episiotomy, use of forceps or vacuum extractions.

Remember the birthing position you choose is entirely up to you to help you deliver safely, and take full advantage of what your body’s designed to do naturally. There are certain medical conditions, such as high blood pressure, that may restrict what position you can safely use.  Discuss with your obstetrician, family doctor and/or midwife the possibilities of using different birthing positions to help minimize the above risks to you and your baby.

Darlene Oakley is a freelance writer for Empowher.com.

Sources:
Best Labor and Birth Positions. GivingBirthNaturally.com. Web. Apr 23, 2012.
http://www.givingbirthnaturally.com/birth-positions.html

Positions for labour. BabyCentre. Web. Apr 23, 2012.
http://www.babycentre.co.uk/pregnancy/labourandbirth/labour/positions

Physiological Management of Normal Labor and Spontaneous Birth. Consortium for the Evidence-based practice of Obstetrics. Web. Apr 23, 2012.
http://www.sciencebasedbirth.com/temporary02/CEO%20synopsis%20Phys%20Mang%2004.htm

Back Labor. American Pregnancy Association. Web. Apr 23, 2012.
http://www.americanpregnancy.org/labornbirth/backlabor.html

“Easing Labor Pain: the complete guide to a more comfortable and rewarding birth” Lieberman, Adrienne. Child Development Institute Parenting Today. Web. Apr 23, 2012.
http://childdevelopmentinfo.com/child-teen-health/easing_labor_pain.shtml

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