As doulas, parents hire us in hopes we can help them have a positive and supported birth experience. One thing we learn as doulas is how important the birth position can be. The position one labors and births in can have a big impact on how their birth unfolds.
Why? Well as you’ve learned or are learning in training, the supine position (laying on back) with legs far apart can close the pelvis by 30% compared to other positions.
When you’re trying to give birth to a whole human, 30% is quite a bit of space you’d want to take advantage of.
How do we help parents understand that birth position matters? Here are some reasons it matters:
Few Birthers Naturally Choose Supine or Lithotomy Positions
As a doula, you value evidenced-based information. An older French obstetrician, Michel Odent, spent much of his carrier observing and documenting behaviors in labor and birth. He also observed how the environment impacted choices.
When left to their own freedom of movement, especially without a bed central to the birthing space, few women naturally chose supine or lithotomy positions. When we give one the space to move and listen to their body, it seems few bodies find comfort in supine positions during labor.
Even when one chooses pharmaceutical pain relief, there is pressure and sensations which are often relieved with alternative positions.
The Use of Gravity – The Birth Position Matters
We would all be a bit uncomfortable if it were suggested we start using the bathroom while lying down. Sure, we could absolutely do so. Yes, people with limited mobility, post-op situations, and sometimes our little ones, all go to the bathroom lying down.
However, it is neither the most natural position nor the most comfortable. Gravity and the ability to relax the pelvic floor are both important.
Benefits of being upright and active during labor and birth include:
- Reduced length of the first stage of labor
- Less need for pharmacological pain relief
- Reduced risk of tearing and pelvic floor damage
- A shorter second stage of labor, some sources citing 40% shorter
A shorter birth with less reported pain is often enough to encourage parents to get upright and moving. It is also helpful to provide education prenatally so they understand this isn’t new information or a trend. Even modern obstetrics was aware as early as the 1930s that the lithotomy position reduces pelvic space.
Unfortunately for many, the convenience and ability for providers to see has made the lithotomy position common.
Help Clients Break The Idea of “Normal” Birth Positions
For clients who have only seen birth on TV or in movies, there’s a strong likelihood that they natural association lying down with giving birth. During prenatal education, you can help clients explore different positions. Help them find positive birth stories showing different positions.
Whether they plan an unmedicated birth or desire an epidural, there are many positions one can labor and birth in.
For those planning an unmedicated birth, the position options are nearly endless. For those with an epidural, magnesium, or other fall risk concerns, there are still many things they can try including:
- Leaning over a birth ball on the bed
- Using a peanut ball between knees and under legs, rotating sides every so often
- Adjusting the L&D bed to be upright
- Making use of the squat bar on the laboring bed
Showing pictures, videos, and having discussions about these alternative positions during the prenatal period will help them be more comfortable exploring options during labor.
Birth Positioning Is a Matter of Empowerment
Helping your clients understand their rights of autonomy and choosing what works best for them can be extremely empowering. Supporting clients in making informed decisions is a big part of your role as a doula.
There is not one right way to give birth, neither are there guarantees about how birth will unfold. However, when clients get to be active participants in the birth planning process, as well as during the birth, they’re more likely to report an empowering birth experience.
On a final note, a wonderful quote from Active Birth by Janet Balaskas, “By deciding to have an active birth you will be reclaiming your fundamental power as a birth-giver, a mother, and a woman. You will be giving your baby the best possible start in life and a safe transition from the womb to the world. Should any unusual difficulty or complication arise, you will be free to make use of the safety net of modern obstetric care, knowing that you have done your very best and also knowing that this is your choice and that intervention was really necessary. In this way, even the most difficult birth can be a positive experience.”
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...