Tuesday, May 3, 2011

Get Off Your Back!

What do you mean you had the baby on your side, standing up, squatting, on your hands and knees?

This picture might seem so weird to some people because all they have known or seen is a woman lying on her back, legs in the stirrups being told to push as someone else counts for 10. Isn't that the way birthing a baby is done? Sadly, it is a common picture however it is by far not the most effective or easiest way to give birth. I hope this post will change the way we picture ourselves giving birth and that women will get off their backs!

My picture for my first birth was me in the tub delivery my baby. Reality was that I was laying flat on my back in the OR being cut open and my baby pulled out of my stomach.

My second birth picture in my mind was again delivering in the tub. Reality was that I was lying on my side on the bed with one leg up resting on my midwifes shoulder.

None of my original pictures or the outcoming reality had me laying on my back with my legs in stirrups, and why not? Because I had read about, witnessed, and my midwives had discussed alternative and better birthing positions.

So what is wrong with being on your back and why is it mostly used in hospital deliveries?

I think the main reason it is the most common position for hospital deliveries is purely convenience for the doctor. It is the easiest position for them to see what is going on, and the easiest access. But I think who cares what is more convenient or easier on the doctor. Who is pushing this baby out, the doctor or the mom? This idea should be changed to what is easier, more comfortable, and more productive for the mom. It is amazing to see and hear stories about midwives and doctors who truely focus more on the mom than their own comfort. They are true contortionists and work around whatever position the mom has chosen is best.

When a woman is laying on her back, or in a c-shape where she is mostly resting on her tailbone with her body curved like a c, her pelvic outlet is up to 30% smaller. That doesn't even make sense to me to be in a position that would make the opening that the baby is moving through smaller in any way. We want positions that help open us up, making it easier for a baby to get through.

This position also puts more pressure on the perineum and other muscles that should be more relaxed not stressed, which can cause worse tearing, unnecessary episiotomies, forceps or vacuum deliveries.

Blood flow and oxygen to both the mom and the baby are reduced when laying on your back because it puts pressure on your vena cava, which is a large vein that returns blood from the lower half of the body to the heart.

Being on your back clearly works against gravity. I would want gravity to aid in birth not work against it so this is another reason to get off your back!

There are a lot of other positions that are better for birthing your baby. Again it is best to try them and see what works best for you in your immediate circumstance. Here are some good ones.

Sitting: This is a position that allows gravity to work with you and help bring the baby down. It can also be a relaxing position for many. This might not be a pretty mental picture but this can be done on the toilet or a birthing stool.

Standing: Again this uses the benefits of gravity to aid delivery. This position also helps get oxygen to the baby. It can also help create a pushing urge.

Squatting: This is the best position to help open up the pelvis and again uses the benefits of gravity working with you.

Hands and Knees: This position is especially helpful when birthing a large baby, back labor, or helping turn a posterior baby. Gravity isn't as effective in this position but it does allow the baby's head to emerge more gently which will lessen the chance of tearing.

Side-lying: This position can be more relaxing but again the aid of gravity is less effective when lying on your side. This position puts less strain on the perineum and helps get oxygen to the baby.

So I hope the vision most of us see when we think of birth will soon move away from the back laying position to one of the many alternatives. Stand with me and tell other women to "Get off your back!"


  1. I'm attempting a VBAC for #3. #1 was vaginal with an Epi and Forceps. #2 was a cesarean with an epi because of fetal distress. I really want to go VBAC because I can't stand the recovery time and additional pains etc that happened with my Cesarean.

    The problem is this: my pain threshold. I cry in anticipation of getting a cavity drilled at the dentist! I was having contractions with #1 for two days before I had dialated enough for them to admit me to the hospital, and I couldn't wait for the relief of an epidural.

    None of the "natural" pain management options look like they are remotely enough for me. I had assumed I could do an epidural with no problems- my OB said that my epi last time did not cause the "fetal distress" that resulted in #2's cesarean birth, but after doing a lot of reading, I'm not sure what to do.

    Moving around makes a lot of sense, but I don't think I am allowed out of bed after an epidural, so I can't have it both ways... I'm either:

    A. Going to cave to Repeat Cesarean because I'm going to be so afraid of or intolerant the pain involved in avoiding an Epidural, or

    B. Have an epidural, feel great and ready to labor, but be forced into a Cesarean because of Fetal Distress or failure to progress.

    Please, is there another way?? My OB seems very supportive of VBAC and says I'm an excellent candidate.

  2. Hi and welcome! Thanks for sharing your story. You know I felt the same way when I first got pregnant that there was no way I would be able to handle it but I did and it felt amazing! I would highly suggest you look into taking some natural birthing classes, such as Bradley Method. I have heard a lot of success stories with hypnobirthing too, although I never looked into that. For me having my baby out of hospital meant I didn't even have the option of an epidural but if I was in a hospital being offered one, it would be a lot easier to give in to it. You might consider hiring a doula who would be there for support, and be there to remind you, you really don't want the epidural and also help make your wishes known to hospital workers so they won't "temp" you with one if that is truly not your desire. A doula also would help you use alternative pain management. I am glad to hear you have a supportive OB, have you been able to bring up these concerns with your doctor?

  3. Well, he just says that there is no proven link between Epidurals and problems like longer labor and fetal heart rate dropping.

    And I DO want the Epi. I AM a wimp.

    I'm due this week, so I'll let you know how it goes. My sister is a doula and will be attending most of my birth.