Childbirth / Motherhood

5 Reasons Why THIS Is One Of The Worst Labor Positions

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The lithotomy position is one of the worst (if not the worst) labor positions. Although no evidence suggests that it is safe or even beneficial to the laboring woman, it is still most commonly assumed during the 2nd stage of labor. From slowing down labor to increasing the risk of trauma, this labor position can negatively impact your natural birth experience.

The lithotomy position calls for you to be flat on your back with your feet up in the air, supported by raised stirrups.  – Photo: Wikimedia Commons

As a mom who has labored on her hands and knees and gave birth squatting twice, I can assure you that if your goal is to have a quicker and an easier natural birth, this is the position you want to avoid! Here are 5 reasons why the lithotomy position is one of the worst labor positions.

5 reasons to avoid laying on your back during labor if you are planning on having a natural birth | One of the worst labor positions

1- It makes your pelvis smaller

Laying down reduces the size of your pelvic outlet by up to a whopping 30%! 

A lot of moving, shifting, and stretching takes place within the bones and ligament of your pelvis during childbirth.

To set yourself up for a smoother and safer natural birth, it’s important that you opt to labor in upright positions which allow for your pelvic outlet to be fully open and aligned. You can labor while standing up, on all-fours, on your knees while leaning forward over an exercise ball for support, etc. All of these positions would keep your pelvis open to accommodate your descending baby.

If you opt to have an epidural, you will have decreased mobility. However with some assistance, you can get into the side-lying position (preferably on your left side), as opposed to the lithotomy position which is assumed in almost all epidural births. A member of your birth team can support your leg and knee, and you can also use a peanut ball which can rest between your legs in-between contractions in order to keep your pelvis open.

This position allows you to relax and preserve your energy, while reducing your chances of tearing. It also leads to more spontaneous births. It is important to note that the side lying position may not be the best position to adopt during the first stage of labor where being upright is vital to the dilation of the cervix and the decent of the baby. 

2- It can slow your labor and weaken contractions

Lying down on your back especially during the first stage of labor slows down the decent of your baby. During the second stage of labor “pushing stage”, the lithotomy position slows the natural physiological process of labor by forcing your body to work much harder against gravity. It’s comparable to pushing a stroller uphill VS pushing a stroller downhill.

It’s a lot harder going up!This labor position also slows blood flow to the uterus making contractions much shorter and much less effective, thus lengthening the duration of your labor unnecessarily.

Contractions are an integral part of labor and play a variety of roles, from helping your cervix dilate, to expelling your baby and placenta out of your uterus. Being in this position increases the risk of exhaustion, perineal trauma, fetal distress, and medical interventions such as the administration of Pitocin (synthetic oxytocin).

3- It increases risk of pelvic floor damage and trauma

It is much more common for women in this position to tear during the 2nd stage of labor (pushing stage). This study which evaluated over 100 000 births revealed that this labor position increased the women’s risk of an obstetric anal sphincter injury which is related to long-term maternal complications such as anal incontinence, sexual dysfunctions, etc.

The lithotomy position is also said to aggravate or trigger symptoms of SPD (symphysis pubic disorder) which can impede your postpartum recovery.
Being upright promotes optimal spinal and pelvic alignment which facilitates the natural physiological process of labor for both mom and baby. 

4- You may experience more pain

In unmedicated births, the lithotomy position actually increases the amount of pain felt during labor. One study revealed significant differences between a group of moms who labored in an upright position and another group who labored lying down.

The finding revealed that the women who labored upright experienced a higher satisfaction with the assumed position. This position increases your risk of getting an epidural which can lead to a cascade of interventions. In an unmedicated birth, being able to move during labor is an important coping mechanism that enables you to relax, and it also gives you a greater sense of control during labor. 

5- It makes labor much harder on your body and on baby’s body

The lithotomy position places all the weight of your growing on your vena cava. The vena cava is a large vein that carries blood from your lower body and torso, to the your heart. Compressing it hinders proper blood flow, lowering your blood pressure. It also directly affects your baby who receives oxygenated blood from you directly from the umbilical cord through the placenta. 

Poor blood circulation to your baby means less oxygen for your baby and this can lead to fetal distress, and ultimately end in a cesarean birth. This can lead to internal fetal monitoring which puts you and the clock and places both you and baby at a higher risk of more invasive medical interventions.  This study found that there was a significant statistical difference in the APGAR scores in neonates born of upright and recumbent moms. 

Although this is one of the most widely practiced labor positions especially in hospital births, there is no evidence that suggests that it is safe or that it promotes a satisfactory experience for the birther or the baby. It’s a position that is most convenient for doctors, and potentially detrimental to the birther and her entire experience with childbirth.

I hope you enjoyed this post!

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  • Noteworthy Mommy
    January 13, 2019 at 12:12 pm

    Very interesting and informative for mommies to be. I had a scheduled c-section so I don’t have any experience in regards to labor and delivery and am not a good resource in his area. I never thought about how unnatural this would be and how it would create extra stress on Mommy and baby.

    • Lifeofababe
      January 15, 2019 at 2:37 pm

      Thanks for reading!!

  • Jewel
    January 13, 2019 at 9:15 am

    I have experienced being forced to stay in this position because my baby was in distress in any other position. I was also induced so it was a very rough experience. I wish I could have stood up or gotten on all 4 to elevate the pressure and pain. Thanks so much for sharing this! Great info

    • Lifeofababe
      January 15, 2019 at 2:14 pm

      Thank you so much for sharing your story, I appreciate it!

  • Marysa
    January 12, 2019 at 7:41 pm

    I had heard that this wasn’t a good way to labor. Interesting to learn about all the reasons behind it. It doesn’t seem very natural when you think about it.

    • Lifeofababe
      January 15, 2019 at 2:09 pm

      Yup- It sure doesn’t! Thanks for reading 😉

  • Bibi on Board
    January 12, 2019 at 2:28 am

    Thank you for this info! I’ll remember it if I give a birth to the potential second one.

    Fortunately, my nurse never suggested me this position. She rather prefer me to jump on a ball, walking or even bath (the best option!)… But in the very end I was so powerless, that I didn’t want anything else than side-laying in a peanut position 😉

    • Lifeofababe
      January 15, 2019 at 2:09 pm

      Side lying is awesome. Helps you rest but still keeps you pelvis open with the peanut ball. You had a great nurse! 🙂 Thanks for reading!

  • Iris
    January 11, 2019 at 6:43 pm

    Wow. This is sooo interesting! I had no idea. I was especially surprised to read it can cause more pain. It’s sad that 100 years ago or so women were strapped in this position for days. No wonder labor took so long.
    As a natural mommy who has her babies at home, I can’t imagine staying in one place while laboring. So thankful to never have put my legs in stirups. Can’t imagine it. Thanks for the blog!

    • Lifeofababe
      January 15, 2019 at 2:08 pm

      Wow you’re such a strong mommy! I’m planning on having my next baby at home as well. My 2 were natural in a hospital though…I can’t imagine having to be on my back it just sounds like it would be very painful and uncomfortable! Thanks for reading!


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