Giving birth on your back? Here's what no one tells you.
Why Are So Many People Still Giving Birth on Their Backs?
If you’ve ever seen a birth in a movie or on TV, chances are the person is lying flat in a hospital bed, legs in stirrups, pushing with everything they’ve got. This position, called lithotomy, is the most common in hospitals. But just because it’s familiar doesn’t mean it’s helpful.
Why is this position still so common?
Even though modern OB textbooks recommend upright pushing positions, especially for first-time births, many providers still encourage people to lie back. Why? It’s often more convenient for the care team.
Lying on your back can make it easier to apply monitors, check dilation, and catch the baby. But for the person giving birth, this position works against gravity and narrows the pelvic outlet. It can actually make pushing harder and more painful.
A 2021 study from Central India found that although many nurses believed upright birth positions are more natural and comfortable, nearly all still reported using the back-lying position in practice. The most common reasons were institutional norms, lack of training, and convenience for staff.
In the United States, those giving birth in a hospital setting are placed on continuous electronic fetal monitoring, which is easier to apply when you are lying down. But continuous monitoring is not always necessary. It has not been shown to improve rates of infant survival or reduce cerebral palsy. What it does increase is the likelihood of cesarean or assisted vaginal birth.
Are there times when lying down can help?
Yes. If a complication like shoulder dystocia occurs, a position where you lie back with your knees pulled tightly toward your chest, can help create more space in the pelvis to release the baby’s shoulder. But for most people, labor benefits from movement.
Which positions actually support your body?
Labor works better when you move. Staying upright and trying different positions can help baby find their way down, make contractions more effective, and lower the chance of interventions. Here are a few to explore:
Squatting beside or in the bed
Standing or leaning forward using a wall or partner for support
Side-lying, alternating with knees bent or straight
Kneeling or hands and knees
Rocking or swaying on a birth ball, while standing, or while sitting on a toilet
These positions use gravity, keep the pelvis open, and give you more control. A 2017 review found that upright pushing may shorten the length of labor, reduce the need for episiotomies, and slightly lower the risk of cesarean birth.
What can you do before labor begins?
Talk to your provider during prenatal visits. Ask clear questions like:
Will I be able to move around in labor?
What birth positions do you support?
How do you handle electronic monitoring?
If their answers don’t match your goals, consider building a care team that supports your vision for birth.
You have options. Your body knows what to do.
At Legacy Postpartum Retreat, we believe in informed care, freedom to move, and birth spaces that center your needs. Whether you are planning a hospital birth or preparing for a postpartum stay, you deserve to feel empowered and supported every step of the way.
Let’s normalize movement and choice in labor. Have a favorite birth position or a story to share? Drop a comment or tag us @Legacy_Retreat to keep the conversation going.
Citations:
Alfirevic, Z., Devane, D., & Gyte, G. M. L. (2017). Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews.
Gupta, J. K., Sood, A., Hofmeyr, G. J., & Vogel, J. P. (2017). Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews.
Tiwari, S., Soni, A., & Patel, S. (2021). Exploring the perspective of nursing staff or caregivers on birthing positions in Central India. Journal of Family Medicine and Primary Care, 10(3), 1149–1154.
