Questioning Childbirth Positions

There are many aspects of the childbirth process that have become so common that they are generally accepted as status quo.  However, when we take a deeper look at the childbirth process, we realize they may not be the best options.  One such area in particular is labor positions.  The “standard” labor position for women has always been lying on their backs in a hospital bed.  However, PROnatal Advisory Board member Ashley Brichter, Certified Childbirth Educator and Founder of Birth Smarter, explains why we may want to question this status quo position.

Traveling Down the Birth Canal Requires SPACE

Before we can begin to discuss childbirth positions, it’s important to understand the journey your little one actually takes to navigate through the complex birth canal.  Take a look at the image below, which shows the fetus inside the uterus.  Notice that the baby’s head does NOT line up perfectly with the vaginal opening.  Therefore, during labor, babies must perform a complex series of movements (known as the cardinal movements) to gradually descend through the pelvis for their much anticipated debut.

Seem complex?  Amazingly, human babies are essentially pre-programmed to perform these movements, BUT they need space to do so.  If we can maximize the amount of space a baby has within the pelvis, we can not only speed this process along but minimize the stress on muscles and tissues within the pelvic bowl (and therefore minimize the risk injury).

How do you maximize the space in your pelvis to encourage the baby’s rotation and descent? We have to find a position that creates the greatest space in the pelvis.  In other words, the pelvis has four boney landmarks that determine the maximum circumference a baby has to fit through: front (pubic bone), back (tail bone), and sides (two sitz bones).  We want to find a position that creates the greatest space between the front, back, and sides.  Here are a few simple movements to find that position.

1. Find the Greatest Space Front to Back

Place one hand on your pubic bone (it’s very low down under the belly, right between your legs. Isn’t it wide!?). Place your other hand on your tail bone. To find your tail bone, invite your hand to feel between the crease of your behind. It is often higher up than most people realize.  You can walk your fingers all the way down the bottom of your spine until you reach the end – and/or lean back on your fingers, like in the image below, in order to feel it more.

Once you have fingers on the pubic bone and fingers on the tail bone, lean forward and feel the space between your fingers. Then lean back. In which direction do you have the most space between your fingers?  Is it when you are leaning forward or leaning back?

If you’re trying this now, the answer should be obvious.  The greatest space is when you are leaning forward.  

2. Find the Greatest Space Side to Side

This is best done sitting down on the edge of a chair. Place your hands underneath your bum and you should feel your two sitz bones protruding down. If you don’t feel them right away wiggle side to side a bit. You should feel boney points digging into your hands. Now, spread your knees out wide (like you’re having a baby!). Feel the space between your fingers.

Then, bring your knees in close together (keeping your feet fairly separated).

In which position do you have more space between your sitz bones? With your knees together, feet apart, or your knees and feet wide?  Surprisingly, you hopefully felt that there is more space when your knees are closer together than our feet. 

Greatest Space = Leaning Forward, Knees Closer than Feet

WAIT. What? That’s right. Pretty different from the status quo.  Most people deliver their babies on their backs with their knees spread wide because this is the most convenient position for hospital staff. If you’re thinking about a physiological birth, looking for ways to possibly shorten your labor, or looking for ways to reduce the risk of tearing, give some serious through to positions that lend themselves to forward leaning and keeping knees closer than feet.

While this may be hard to grasp, consider this.  Leaning back (or lying down) makes the tailbone stick inward. It limits the amount of space a baby has to rotate and it essentially asks your body to push a baby UPHILL.  Upright and forward leaning positions will allow the tailbone to get out of the way.  Granted, you would need to deliver with a provider, and in a location, that is supportive of this.

Want more information to help you prepare for childbirth?  Check out our 3-Part Childbirth Preparation Series. 

Ashley Brichter is the founder of Birth Smarter, a company committed to providing relevant and engaging educational services to expectant and new parents.  She is also a Certified Cooperative Childbirth Educator through CEA/MNY, a DONA trained Birth and Postpartum Doula, Certified Lactation Counselor, and mother of two.  Ashley is also trained in Comforting Touch for Labor, Rebozo Techniques for Childbirth, Dream Birth Imagery, Spinning Babies, Prenatal Yoga, and Pelvic Health. In addition to teaching live childbirth education, breastfeeding, and newborn care classes throughout New York City, Ashley is immersed in the world of pelvic health and restorative fitness for perinatal women.