The term childbirth positions (or maternal birthing positions) refers to the physical postures the pregnant mother may assume during the process of

childbirth Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births glob ...

. They may also be referred to as delivery positions or labor positions. In addition to the

lithotomy position The lithotomy position is a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations. The lithotomy position involves the positioning of ...

(on back with feet pulled up), still commonly used by many

obstetricians Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a sur ...

, other positions are successfully used by

midwives A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their lifespan; con ...

and traditional birth-attendants around the world. Engelmann's seminal 1882 work "Labor among primitive peoples" publicised the childbirth positions amongst primitive cultures to the Western world. They frequently use

squatting Squatting is the action of occupying an abandoned or unoccupied area of land or a building, usually residential, that the squatter does not own, rent or otherwise have lawful permission to use. The United Nations estimated in 2003 that there ...

standing Standing, also referred to as orthostasis, is a position in which the body is held in an ''erect'' ("orthostatic") position and supported only by the feet. Although seemingly static, the body rocks slightly back and forth from the ankle in the s ...

kneeling Kneeling is a basic human position where one or both knees touch the ground. Kneeling is defined as “to position the body so that one or both knees rest on the floor,” according to Merriam-Webster. Kneeling when only composed of one knee, and ...

and all fours positions, often in a sequence. They are referred to as ''upright birth positions''.

Lithotomy position

In the lithotomy position, the mother is lying on her back with her legs up in stirrups and her buttocks close to the edge of the table. This position is convenient for the caregiver because it permits him or her more access to the

perineum The perineum in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), includi ...

. However, this is not a comfortable position for most patients, considering the pressure on the vaginal walls because the baby's head is uneven and the labor process is working against gravity.

Upright birth positions in general

Various people have promoted the adoption of upright birthing positions, particularly squatting, for Western countries, such as

Grantly Dick-Read Grantly Dick-Read (26 January 1890 – 11 June 1959) was a British obstetrician and a leading advocate of natural childbirth. Early life and education Dr. Grantly Dick-Read was born in Beccles, Suffolk on 26 January 1890, the son of a Norfolk ...

Janet Balaskas Janet Balaskas is an author, founder of the Active Birth Movement, and childbirth educator. She is perhaps known best for her advocacy of ''active birth'' where the woman is free to move during labour, rather than being placed into stirrups or ...

Moysés Paciornik Moysés Goldstein Paciornik (4 October 1914 – 26 December 2008) was a Brazilian physician. He was born in the city of Curitiba in the Paraná state, located in Southern Brazil. He graduated in Medicine in 1938. In 1959 he founded the Paranaen ...

and

Hugo Sabatino Hugo Sabatino is an Argentine-Brazilian physician, scientist and university professor affiliated to the Medical School of the State University of Campinas, in Campinas, State of São Paulo. Sabatino's main specialty is obstetrics. He has contribute ...

. The adoption of the non-lithotomy positions is also promoted by the

natural childbirth Natural childbirth is childbirth without routine medical interventions, particularly anesthesia. Natural childbirth arose in opposition to the techno-medical model of childbirth that has recently gained popularity in industrialized societies. Natur ...

movement. Being upright during labour and birth can increase the available space within the pelvis by 28–30% giving more room to the baby for rotation and descent. There is also a 54% decreased incidence of foetal heart rate abnormalities when the mother is upright. These birthing positions can also reduce the duration of the second stage of labour as well as reduce the risk for emergency

caesarian section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...

s by 29%. They are also associated with the lower need for

epidural Epidural administration (from Ancient Greek ἐπί, , upon" + ''dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and ...

. Different positions may be associated with different rates of perineal injury.

Squatting position

Pre-Columbian collection, Dumbarton OaksDSCF7954

The squatting position gives a greater increase of pressure in the pelvic cavity with minimal muscular effort. The birth canal will open 20 to 30% more in a squat than in any other position. It is recommended for the second stage of childbirth.Russell JG. Moulding of the pelvic outlet. J Obstet Gynaecol Br Commonw 1969;76:817–20. As most Western adults find it difficult to squat with heels down, compromises are often made such as putting a support under the elevated heels or another person supporting the squatter. In ancient Egypt, women delivered babies while squatting on a pair of

brick A brick is a type of block used to build walls, pavements and other elements in masonry construction. Properly, the term ''brick'' denotes a block composed of dried clay, but is now also used informally to denote other chemically cured cons ...

s, known as ''birth bricks''.

All-fours

Some mothers may choose the all-fours position instinctively. It can help the baby turn around in the case of a malpresentation of the head. Since this position uses gravity, it decreases back pain, as the mother is able to tilt her hips.

Side lying

Side lying may help slow the baby's descent down the birth canal, thereby giving the perineum more time to naturally stretch. To assume this position, the mother lies on her side with her knees bent. To push, a slight rolling movement is used such that the mother is propped up on one elbow is needed, while one leg is held up. This position does not use gravity but still holds an advantage over the lithotomy position, as it does not position the

venae cavae In anatomy, the venae cavae (; singular: vena cava ; ) are two large veins (great vessels) that return deoxygenated blood from the body into the heart. In humans they are the superior vena cava and the inferior vena cava, and both empty into the ...

under the

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...

, which decreases blood flow to mother and child.

References