Imagine a woman giving birth. What position do you see her in? If like most people, your views on birth have been shaped by what you see on tv and in the movies, you likely imagine her lying flat on her back in a hospital bed. Traditionally birth took place at home, and people formed their impressions by direct experience. When birth was largely institutionalized in the United States in the first half of the last century, most people no longer witnessed births, except those of their own children, and so media images came to replace live ones. For more information on the way that media influences our perceptions of birth, I highly recommend the documentary Laboring Under an Illusion.
Lying flat on the back, also known as the lithotomy position, turns out to be one of the hardest positions there is to give birth in (short of standing on your head!) It can cause non-reassuring fetal heart tones and more pain. The more upright the laboring mother is, the more gravity will help her baby to descend. I tell my childbirth classes that labor is the one time in a woman’s life when gravity is her friend! Very few un-medicated women would ever choose to labor on their backs. In labor, we get important signals from our bodies about what positions are best. Women who labor in the positions of their choice experience shorter labors than those whose movement is restricted.
Squatting gives the baby the most room to descend. The female pelvis is thirty percent bigger when squatting, than it is when lying flat. Thirty percent is a lot! Because of that, when women squat their babies descend more quickly, with less pressure. Squatting is called the midwives forceps. Midwives don’t actually use forceps, but the idea is that when the mother squats with the midwife’s encouragement, the baby comes as quickly as if she had.
In many places in the world where people live without cookstoves or toilets, they squat frequently. Because Americans over the age of three or four rarely squat, getting reacquainted with the squat during your pregnancy is worthwhile. You can do a free squat, hold on to someone or something, or squat with your back against the wall. Place your feet far enough apart that you can get your heels flat on the floor.
Hands and knees, or knee-chest, is an excellent position for back labor because it helps to move the pressure off the mother’s back. Back labor is often caused by the back of the baby’s head, rather than her face, being against the mother’s spine. This position can often cause a longer labor, because the baby usually needs to rotate to be born. Knee-chest helps to rotate the baby into an easier position. For information on how to prevent and handle back labor, Spinning Babies is an excellent resource.
A position to try when labor is slow is lunging. If lunging on a side feels neutral, try lunging the other way. Often one side will feel really good. When a baby is asynclitic (crooked) his head is disproportionately on one side. Lunging will feel good because it opens the pelvis to relieve some of the pressure, while also give the baby room to rearrange her head.
A good childbirth class will give you the opportunity to practice these positions and learn more as well. Understanding them is not enough. It’s important to experience them prenatally and use them as tools if needed in labor.