Birth Positions for Labour

We’ve all seen films and television programmes where women give birth.  Women are usually on the bed, on their back, with their legs in stirrups.  That’s how it’s supposed to be right?  Maybe not…

Why not your back?

Being on your back is certainly one way to give birth, but it may not be the easiest or most comfortable position to be in.  Although this is what we’re familiar with as a society, being on your back actually narrows your pelvis.  It therefore reduces the space that your baby has to move through your birth canal and be born.

Don’t believe me?  Test it out for yourself.  Put one hand on your bone at the front of your pelvis (where your midwife presses when she is measuring your bump) and one at the base of your spine.  Now lean forwards and backwards and take note of what is happening to your hands.  You will notice that, as you lean backwards, your hands move inwards and as you lean forwards they move further apart.  Research has shown that that the pelvis can increase by 2cms, by changing position. That’s 1/5th of a baby’s head!

Many women also find being on their back more painful.  Especially if you are experiencing your contractions in your back.  Whereas movement can provide comfort.

Pushing is usually more difficult on your back.  That is because you are exaggerating the bend in your vagina by having your legs placed in front of your abdomen.  So for baby to make their exit, you actually end up pushing upwards, fighting against gravity.

Stirrups

There are also complications associated with having your legs in stirrups (also called lithotomy by health professionals).  Not only does it narrow the space for your baby to be born, it increases the pressure being put on your perineum (the muscles in between your vagina and rectum).  That means that you are increasing the chances of tearing.

So why are stirrups used at all?  They were actually designed by doctors to aid them with instrumental births.  They make it easier for doctors to get closer to you, to be able to put on the instrument being used to aid the birth of your baby.  So it is entirely appropriate for them to be used in this situation.

However, if you are not having an instrumental birth, there is no benefit in using stirrups.  So why might you be advised to use them?  Unfortunately some practitioners believe that it will speed up the birth of your baby, even though there is no evidence to support this.  The reason they believe that is because the extra tension placed on your perineum, means that the walls of your vagina are pulled up, which artificially makes the baby appear as though it is further down your vagina and closer to being born.

Being upright

Being upright is shown in research to make labour more comfortable, shorter and reduce interventions.  That is because gravity aids the descent of baby, there’s more likely to be equal pressure on your cervix, helping it to dilate.  Your pelvis is also wider.  This gives baby more space to move, as babies need to go through a series of turns inside their mothers in order to be born.  There are so many options to choose from:

• Standing
• Squatting
• Kneeling
• Sitting
• All fours
• Lying on your side
• KICO

KICO

All fours

Standing

Squatting

Support squatting

What is KICO?

KICO stands for; Knees In, Calves Out.  This position widens the pelvic outlet for baby during pushing.  It sounds contradictory, as it is the exact opposite of the “woman giving birth in stirrups” image that many of us conjure up.  Surely closing your legs can’t give space for a baby to be born?! Let’s test this theory out… place your hands under your bottom, so you can feel the bony part of your pelvis.  Now, put your feet together and drop your knees apart.  Notice where those bones go.  Now do the opposite, knees together, feet as wide apart as you can get them.  Did you feel your pelvic bones move outwards?  You may need to repeat the movement a few times to feel what is happening in your pelvis, as your brain often tries to tell you what your feeling is wrong.

A Word of Caution

Not all positions are beneficial for all women.  Whilst squatting utilises gravity to aid descent, it can also increase the tension placed on your perineum, just like with stirrups.  As such, giving birth in this position has been shown to increase the chances of tearing.  If you find squatting useful for pushing, feel free, but you may want to consider dropping into a kneeling, all fours or side lying position as baby is crowning to reduce the likelihood of tearing.

Epidurals

Obviously moving around in labour can be more difficult if you have an epidural in place.  It shouldn’t mean that your only option is lying on your back though.  There are two types of epidural; mobile and standard.  With a standard epidural, you will not be able to move your legs.  However with a mobile epidural you may find that you are mobile enough to stand next to the bed and lean on it, or sit on a birthing ball.  Your healthcare provider can help you to figure out if you are able to weight bare before you get out of bed.

Even if you are not able to do either of these, most beds on labour wards are able to move into a variety of positions, such as becoming a chair.  You may also want to lie on your side.  A peanut ball can be placed between your legs, this can help to open up your pelvis.  Research has shown that using one can shorten the length of your labour and reduce the likelihood of a caesarean birth.

Top Tips For Birth Positions In Labour

• Tune into your intuition – often you will find yourself naturally wanting to move in a particular way. Lean into it.  You may not understand why, but there’s often a reason your body is telling you to move in a particular way.  Even if your body tells you to be on your back.  For a few women, that is where they need to be to give birth.
• Use support – you may find it tiring to maintain an upright position by yourself, so use support. Whether that’s another person, a bed, sofa, toilet, birthing ball, wall or kitchen counter. Many ordinary items can become great tools to lean on in labour.
• Move the bed out of the way – particularly if you’re planning a hospital birth, quite often the bed is the focal point of the room. Ask your care providers if you can move it to one side so that you can have more freedom of movement.  You can also ask if there are any other tools you could use instead, such as: birthing ball, birthing stool or mat.
• Don’t just stick to one position – research actually shows that changing positions helps encourage progress in labour. So try not to get fixed on staying in one position throughout.
• Consider a pool birth – not only does the warm water provide comfort from the contractions, you will also find that you are more mobile in water. The buoyancy of the water takes the weight of your bump, making you feel lighter than you have felt in months.  Also if you have been suffering from pelvic pain, the water may provide some relief, making you feel more flexible.

Where Can I Find More Information?

• https://www.spinningbabies.com/pregnancy-birth/the-three-principles-in-pregnancy/
• https://www.optimalbirth.co.uk/index.php/pregnancy-birth-and-newborns/moving-for-an-easier-birth-part-one
• https://uat.rcm.org.uk/media/2313/rcm-a3-positions-poster-download.pdf

Need Help With Your Birth Plans?

There are so many options to consider when planning the birth of your child. If you would like help with this take a look at our Birth Plans or our birth options

Reach out to us at Private Midwives for further support, you don’t have to go through this alone! If you would like to know how we can support you with the birth of your child feel free to call us on 0800 3800 579 or book an antenatal appointment here