Normal Birth Characteristic #5 Pushing occurs in any position but flat-on-back

  Almost every woman gives birth on her back. Especially in the hospital where the bed is at the center of the room, and it conveniently “breaks down” to make it “easier to push your baby out. Since the 16th century, women in Europe have been giving birth in a semi-sitting or lithotomy position, and this method has traveled to most industrialized countries. Scholars claim that King Louis XIV made his wife to give birth lying down so that he could peer from behind a curtain to watch his child being born. And while history tells us that he did have great influence over this practice, doctors of that time were also convincing women to give birth on their backs, as delivering babies from mothers lying on tables is much easier to do than if they are squatting, standing, or on hands and knees to deliver. Sometimes, doctors today will even tell us that it is for our own safety that we delivery on our backs, but is that true?


(me, pushing on my back)

  The only time when being on her back is beneficial is when the baby is stuck, and lying flat on her back (head not raised) and pulling her knees toward her shoulders so that her hips are off the bed will give the maximum room for the baby to come out. This position should not be tried first, however, since it can still slow the pushing phase, and lower the mother’s blood pressure (and therefore the baby’s).

  For all other cases, delivering on your back or in a semi-sitting position are actually the worst positions. Consequences include:

  • Tearing
  • Urinary incontinence later in life
  • Nee for highly-coached pushing which also increases tears and incontinence
  • Episiotomy, which increases incontinence, and of course tearing
  • Fetal distress, since these positions compress the major artery that brings the baby oxygen
  • Increased pain of contrations
  • Back pain during labor and afterwards
  • Longer pushing time
  • Forceps, vacuum extraction, and cesarean section for “failure to progress”

  The next question is, what is so good about upright pushing positions that they result in fewer of the above complications than the lithotomy or semi-sitting positions?

  As I mentioned in my normal birth post #2, the woman’s pelvis is a remarkable living structure. The pelvis is made of three bones joined by flexible ligaments. During pregnancy the hormones Progesterone and Relaxin soften these bones and ligaments even more. During the usually slow and steady process of labor, the baby’s head (which is designed to mold to the pelvis) gently spreads the pelvis, open like a flower, so there is room for her to come through. Because of this well-designed process, mothers are able to birth even very big babies through their pelvis. But there are a few thing sthat can make her effort harder than it has to be, and one of them is pushing on her back.

  Lying one’s back not only prevents gravity from assisting a woman in moving her baby down through her pelvis, but it also severly restricts the pelvis’ ability to open. Being upright without putting pressure on her pelvis can open it by as much as 20-30% more, whereas lying on her back closes her pelvis by 20-30%! This make a big difference when birthing a baby.

  Some good upright positions to try pushing and delivering in are standing and leaning onto your partner or the bed, sitting on a birthing stool or the toilet, squatting, hands and knees, or kneeling and swaying in the bath. Your doula can help you to find comfortable positions if you feel lost. It is actually best if you change positions every 20 or 30 minutes to encourage your baby to move downward and to increase your comfort and stamina.

  Other benefits of being upright to push and to delivery your baby are that you will feel more in control and have higher satisfaction of the birth, there may be less trauma to both you and your baby, and your baby may even have less molding of her head.

  I can say from personal experience what a difference it makes to push upright. I birthed my first baby lying on my back. I was tired, but that position seemed to keep me from pushing well. My midwife kept asking me if I would be willing to sit on the birth stool, but I didn’t feel like I had enough energy. So after an hour or so my baby was finally born.

  My second baby was born at home after a much shorter labor, but this time I found myself pushing while sitting on the toilet. Instead of pushing because I was supposed to, I pushed because I had to, and this upright pushing was not only easier but more gratifying. Within a few minutes, her head was out, I stood up and the midwife caught my baby. And although my first baby weighing 8lbs 2oz had some molding after birth, my second baby who weighed 8lbs 8oz had a perfectly round “c-section” head.


(me, pushing on the toilet, leaning over the diaper pail)

  There are almost no justifiable reasons for a woman to give birth lying down, and even then she should usually be on her side. Talk to your doctor or midwife about your concerns of pushing on your back, and ask about what position(s) they encourage their patients to use while pushing. If he/she says their patients usually deliver on the table, you know that you will either have to fight to delivery upright or you will need to start looking for another doctor or midwife. And the reward for doing so will be great for both you and your baby.


  1. Block, Jennifer. Pushed. Da Capo: Cambridge. (2007)
  2. Wagner, Marsden, M.D., M.S. Creating Your Birth Plan. Berkley: New York. (2006)
  3. Enkin, Keirse, Renfrew, & Neilson. A Guide to Effective Care in Pregnancy and Childbirth. Oxford University: New York. (1995)
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