Upright Versus Lying Down Positions For Giving Birth

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Positions Giving Birth

The majority of women in the US give birth either lying on their backs (57%) or in a semi-sitting/lying position (35%), while only 4% try alternative positions for giving birth such as squatting/sitting or on hands-knees.1 Most women are encouraged to give birth lying or in semi-sitting position because that makes it easier for accessing the abdomen to monitor the fetal heart rate.1

However, pushing in an upright position can be beneficial for birthing. Following are some of the reasons:

  • It uses gravity to assist in bringing the baby down and out
  • It has lower risk of compressing the mother’s aorta (and, consequently, the oxygen supply to the baby is improved)
  • It helps the uterus contract more strongly and efficiently
  • It helps get the baby into a better position for passing through the pelvis
  • X-ray evidence has shown that the actual dimensions of the pelvic outlet become wider in the kneeling/hands-knees and squatting positions.1,2

Benefits and risks of pushing positions

A 2012 study pooled together the results of 7200 women participating in 22 studies and compared non-upright versus upright birthing positions. Upright birthing positions were associated with:

  • 23% fewer forceps or vacuum-assisted deliveries
  • 54% fewer women with abnormal fetal heart rate patterns
  • 21% fewer episiotomies2

However, upright birthing positions were also associated with 35% more women with second-degree tears and 65% more women with blood loss of more than 500 mL, compared with lying down positions. No differences between the groups were found with respect to Cesarean sections, need for blood transfusion, third or fourth perianal tears, admission to neonatal intensive care units, or perinatal deaths.2

The effects of pushing positions in women who have an epidural

In the US, the majority of women (71%) receive an epidural during childbirth.3 In contrast with the many studies of birth positions in women not receiving an epidural, evidence regarding birthing positions for women receiving an epidural is limited. Two studies were performed in women who received ‘walking epidurals’. One study found that women who who were upright (during both stages of labor) experienced a significantly shorter overall labor time, from epidural administration to delivery (173 minutes) compared with women who were not upright (236 minutes).4 Another study found that first-time mothers who were upright during the second (pushing) stage of labor had a significantly shorter pushing time (51 minutes) compared with first-time mothers who remained lying down (73 minutes).5 Unfortunately, there are very few studies assessing birthing positions in women who have received traditional (non-walking) epidurals.

In summary,  should give birth in whatever position they find the most comfortable. Benefits exist for all types of birthing positions and, therefore, it is up to the woman to choose the position she prefers.

References:

  1. What is the evidence for pushing positions?
  2. Position in the second stage of labour for women without epidural anaesthesia
  3. Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences
  4. Ambulatory epidural anesthesia and the duration of labor
  5. Upright versus recumbent postion in the second stage of labour in women with combined spinal-epidural analgesia
Melody Watson
Melody Watson holds Bachelors degrees in Biochemistry and Microbiology. She works as a medical writer for a medical communications agency in Berlin, Germany, where her work ranges from medical translation to writing publications for medical journals. Melody is passionate about promoting science, including evidence-based medicine, and debunking pseudoscience.

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