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INTRODUCTION

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I want to birth my baby in the position that is most comfortable for me

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I was really happy with my birth experience overall. I had a doula and a birth plan and the hospital staff was really supportive, but when the time came to push, they wanted me to lay on my back to deliver, which went against everything my body was telling me. Hands and knees had been the most comfortable position for me throughout the labor and I really did not want to turn around, but my doctor had never delivered a baby in that position and didn’t feel like it was safe.

—D. H., new mother

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The most common positions for delivery remain dorsal lithotomy (68% of vaginal deliveries) and semi-seated (23% of vaginal deliveries).1 In the dorsal lithotomy position, the delivering woman is flat on the back with the legs widely spread, flexed at the knee and the hip, and raised with the help of labor assistants or stirrups. The semi-seated position is similar to dorsal lithotomy, except the head of the bed is raised approximately 45 degrees and legs are often not as elevated (Figure 7-1).

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FIGURE 7-1

The most common positions for delivery remains. (A) dorsal lithotomy (68% of vaginal deliveries) and (B) semi-seated (23% of vaginal deliveries).

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There are several reasons the majority of women deliver in these position, the first being that the majority of women have epidurals which simply limit their ability to deliver in alternative positions, as they are immobilized from the waist down. Second, due to this overwhelming percentage of women delivering with epidurals and the history of obstetrics that saw the majority of deliveries occurring with the aid of forceps, which necessitated a dorsal lithotomy position, most obstetricians are exclusively taught to deliver babies in a supine position and are only comfortable delivering in this manner. There is also a commonly expressed concern among obstetricians that if a complication arose, such as a shoulder dystocia or an umbilical cord around the neck, it could not be easily remedied in an alternative position. Finally, supine positions for delivery facilitate continuous electronic fetal monitoring.

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Unfortunately, supine positions have been shown to have several disadvantages and there are benefits associated with alternative positions, such as side-lying, squatting, and hands-and-knees positioning. There is a higher incidence of vaginal lacerations, including severe tears that injure the anal sphincter, and episiotomies in patients in lithotomy positions. Lateral, or side-lying, positions have been shown to have a decreased rate of perineal lacerations and squatting and up-right positions for delivery have been shown to shorten the second stage of labor, especially with the aid of a birth stool.24 Less fetal heart rate changes have also been noted with alternative positions, which ...

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