Giving Birth Flat on Your Back

When it comes to childbirth, there's one position that's often instinctively associated with the big moment - lying flat on your back.

It's the image we've all seen in movies, TV shows, and hospital rooms, and it's often seen as the "traditional" or "default" way to give birth.

But is it really the best way to bring your baby into the world?

Is Giving Birth on Your Back the Best Option?

When a woman gives birth on her back, it can lead to a range of complications, including prolonged labor, increased risk of medical interventions, and even injuries to the perineum.

This is because lying flat on your back can cause the baby to move into a more posterior position, making it harder for the baby to move through the birth canal.

Additionally, it can also lead to a higher risk of fetal distress, which can be stressful for both mom and baby.

Giving birth flat on your back (the classic 'lithotomy' or semi-reclined hospital-bed position) is still the default in many hospitals, but it's actually the worst position for most labors from a physiological standpoint.

Why Lying Flat on Your Back Is Usually a Bad Idea

1. Smaller pelvic outlet

The sacrum can't move backward → pelvic outlet is ~30% smaller than in upright or hands-and-knees positions.

2. Baby fights gravity.

Baby has to push uphill instead of down with gravity.

3. Worse contractions

Compression of the aorta and vena cava (supine hypotensive syndrome) → less oxygen to uterus → weaker, less efficient contractions

4. More tearing

The angle puts maximum pressure on the perineum instead of letting it stretch gradually

5. Higher intervention rates

Meta-analyses show lithotomy/semi-reclined → ↑ forceps/vacuum (55%), ↑ severe tearing, ↑ emergency c-section for 'failure to progress'

Evidence - WHO, ACOG, and the Royal College of Midwives.

It is recommended to avoid supine positions unless medically necessary.

Cochrane review (2024): Upright positions in second stage → 25% shorter pushing time, 20-30% lower chance of instrumental delivery or episiotomy.

Real-world hospital data: Places that switched to mostly upright/side-lying births (e.g., parts of the UK, Netherlands, many birth centers) have episiotomy rates <5% and c-section rates 10-15% lower.

Better Positions to Try

1. Side-lying

2. Hands-and-knees

3. Squatting or throne position

4. Forward-leaning / kneeling

5. Standing / slow dancing

Research about Birthing on Your Back

Furthermore, research has shown that giving birth on your back can also increase the risk of unnecessary medical interventions, such as episiotomies, forceps deliveries, and even c-sections.

This is because doctors may feel the need to intervene more frequently when the birth is not progressing as smoothly as they'd like. And let's not forget the physical toll it can take on the mother - lying flat on your back can put pressure on the spine and pelvis, leading to back pain and discomfort during and after labor.

But what about the impact on the baby?

Unfortunately, studies have shown that giving birth on your back can also increase the risk of birth injuries, such as broken collarbones or shoulder dystocia. This is because the baby's passage through the birth canal can be restricted, leading to a more traumatic birth experience.

So, what's the alternative?

What if I told you that there are other birth positions that can make a huge difference in the safety and comfort of both mom and baby?

Positions like kneeling, standing, or even squatting can help the baby move into a more optimal position, reducing the risk of complications and making labor more efficient.

What about Upright Positions?

Studies have shown that upright positions can increase the efficiency of contractions, reduce the need for pain relief, and even shorten the length of labor. And let's not forget the empowerment that comes with being able to move freely and take control of your own birth experience.

What Should You Do?

It's a personal decision for you. Chat to your doctor. Giving birth flat on your back may seem like the most traditional or comfortable option, but it's not always the safest or most effective.

By being aware of the potential risks and considering alternative birth positions, we can take back control of our own birth experiences and make informed choices that prioritize the safety and well-being of both mom and baby.

Why did the 'birthing on your back' trend start?

Yes it's in all the movies, but it was evident before then

You can blame French King Louis XIV (1638-1715). He enjoyed watching women giving birth and became frustrated by the obscured view when birth happened on a birthing stool.

So, yes, you guessed it HE promoted birth on the back being the new way to birth.

Well, it's not about 'seeing better'; for the health care provider. It's about birthing better for the woman. Would you agree?

Despite ALL the evidence supporting 'sacrum-freeing' positions like squatting, kneeling, side lying to speed labor and open the pelvic outlet - we are told we must birth on our back?

Watch Video Birthing on Your Back

Read that again.

Also, you do not 'need' to be on your back for pushing just because you get an epidural.
Speak up Mama. Have these conversations in your antenatal appointments, don't just assume things will be done to benefit you in the birthing suite.

You have options girl.

Of course, if you WANT to birth on your back, all the power to you - but YOU should have choice and an understanding on how it impacts you, your body and your progression of labor.

For an idea on Birthing positions check out this FREE Active Birth Class

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Starting right now, do not let the fear of the unknown keep you from your empowering birth experience.