12/06/2025
Why Your Birth Position Matters More Than You Think
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Throughout history, women have instinctively birthed in upright positions—squatting, kneeling, standing, using birth stools. It’s only in the last few centuries that Western medicine convinced us to lie on our backs. But here’s what the research shows:
The Lithotomy/Supine Problem:
When you give birth lying flat or in lithotomy position (on your back with legs in stirrups), you face significantly higher risks of severe perineal trauma—particularly when instrumental delivery is involved . Research shows lithotomy and supine positions are associated with longer labor, greater pain, more abnormal fetal heart rate patterns, and increased severe perineal trauma.
Studies confirm that upright positions result in shorter second stage of labor, less intense pain, fewer instrumental deliveries, fewer abnormal fetal heart rate patterns, and fewer episiotomies compared to supine or lithotomy positions.
The Provider Convenience Factor:
Here’s the uncomfortable truth: A study l found that 100% of labor and delivery nurses reported lithotomy as the most commonly used birthing position specifically because of “the ease and convenience of the doctors and health care providers” .
If physicians have only been trained in back-lying positions, they may not feel equipped to handle unexpected situations when the birthing person is upright . This training gap—not evidence—drives position choices. While it’s claimed the dorsal position enables better fetal monitoring to ensure safe birth, it may actually just be more convenient and give better control for the caregiver.
When you’re lying down, providers have easier visual and physical access to your perineum. This often leads to more hands-on delivery techniques, including perineal “massage,” episiotomy, forceps, vacuum extraction, and other interventions that may not be necessary when physiologic birth is allowed to unfold.
What Are Upright Positions?
Upright or vertical positions include:
• Squatting (with or without a bar or birth stool)
• Kneeling (on all fours or upright kneeling)
• Standing
• Sitting on a birth ball or stool
• Side-lying (often grouped with upright positions)
• Any position where the angle between your spine and horizontal plane is greater than 45 degrees
Benefits of Upright Birth:
✨ Reduced second stage duration (about 6 minutes shorter on average)
✨ Works with gravity instead of against it
✨ Increases available pelvic space by 28-30%, giving your baby more room for rotation and descent
✨ 54% decreased incidence of fetal heart rate abnormalities
✨ 29% reduction in emergency cesarean sections
✨ Fewer instrumental deliveries
✨ Fewer episiotomies
✨ Less intense pain reported
✨ Better uterine contractions
✨ Greater maternal satisfaction and sense of control
What About Epidurals?
Yes, you can still birth upright with an epidural! While high-dose epidurals may make independent movement challenging, with proper support from trained staff, many upright and side-lying positions are absolutely possible. The key is having a care team knowledgeable about supporting physiologic positioning even with pain relief.
The Bottom Line:
Your body was designed to birth upright. When you lie on your back, you’re fighting gravity, compressing major blood vessels, reducing your pelvic space, and making your body work harder. The lithotomy position exists primarily for provider convenience—not because it’s what’s best for you or your baby.
Ask your provider about their experience with upright birth positions. Will they support your movement in labor? Have they been trained to catch babies in various positions? Your birth, your body, your choice—and the evidence is clear about what works best physiologically.
💚 Knowledge is power. Your body knows how to birth.
