13 Reasons Not To Labour And Birth On Your Back
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There’s a catchy little saying that each month has an average of 30 days, except for the last month of pregnancy which has 1368 days. Although it may not feel like it, pregnancy comes to an end, and ready or not, labour and birth will happen.
Whether you are in the early stages of pregnancy, or expecting a newborn babe any day now, it is never too early or too late to learn how to make labour easier and faster. One of the most effective ways to do this is incredibly simple – just don’t lay down.
In the early stages of labour, any good Midwife will tell you this is the time to rest, hydrate, and nourish. And yes, rest sometimes requires laying down. But once you are in an active labour, and your surges (contractions) have become regular and powerful, it is time to get up and move around like the birthing goddess you are.
It is generally instinctive to want to be upright in labour. Our pelvis is designed to birth that way, and gravity facilitates birth. We are primal beings, and we really need to tap into the primal brain, and turn off the thinking brain, to promote easier labour and birth. Our hormones do this for us – endorphins and oxytocin wash over us, acting as natural pain relievers, and helping labour progress.
But sometimes in labour and birth, external elements can hinder this hormonal process and impact our ability to trust our instinct to be upright and active.
Our previous exposure to birth images plays a huge part – how many movies have you seen with women birthing on their back in stirrups? The majority of on-screen birth is portrayed this way, yet it is nothing like reality. If you haven’t yet, go scour the internet for ‘positive birth videos’. You’ll see just how different they look to the images of birth you’ve been drip fed since your youth, and change your idea of what birth looks like.
Other external elements that can hinder our instinct to move about in labour is the birth space setting and carer. Having supported women in both hospital and home births, it is obvious what is most conducive to easier labour and birth. That is a mother who feels safe, comfortable and unobserved in her environment.
Now I’m not comparing homebirth to hospital birth – I am a firm believer that women will birth best where they feel safest – but inherently women birthing at home are more likely to feel comfortable and unobserved as it is their own environment.
So too, hospital birth spaces can be supportive of instinctual, physiological birth. But this can really depend on whether your care provider respects and understands that.
If your hospital birth suite has bright lights, lots of machines and obscure technology, clinical posters, or unfamiliar faces are talking at you, forcing the thinking brain to turn on, that’s not ideal. A labouring mother will be more likely to feel like she is a patient having a procedure done to her, rather than a woman birthing her babe, the lead decision maker, being supported and informed by professionals. Therefore, more likely to feel like she has to lay on the big, crisply starched, white bed in the centre of the room.
If your carers aren’t comfortable catching babies in any other position than on the bed – that’s an alarm bell. If you’re not supported to use active comfort strategies, suitable to your individual circumstances, like gym balls, walking, shower, bath… getting off your back – that’s an alarm bell. A need for external monitoring of baby’s heart rate alone should never be a reason to require laying on your back.
In essence, every woman’s individual circumstances, birth preferences and wellbeing play a part in where and how it is safest for her to labour, but for the majority of women, active upright birth is not only suitable, but preferable, so we’ve compiled 13 reasons why not to labour and birth on your back.
1. Pelvis Size
Recumbent and semi-recumbent positions in labour can reduce your pelvic outlet size by up to 30%. Woah, wait, what!? Thirty percent. Three – Zero. Almost a third less space for your baby to move down and rotate around the pelvis. Not to mention a third less space to be born through when Mama is working fiercely hard to get baby out.
2. Significant Tears
Birthing on all-fours or kneeling is known to be the most protective factor of the perineum with regards to position for birth. Time and time again, studies have found that women are less likely to experience genital trauma requiring repair (stitches) if utilising these upright positions.
In most clinical settings in Australia, episiotomies are very rarely used and reserved only for circumstances of trying to prevent significant trauma involving the anus (if it appears this is about to occur at the time of crowning) and to hasten birth in the event baby’s heart rate is dangerously low.
Giving birth lying on your back, particularly if legs are in stirrups or a similar position, makes you more likely to have an episiotomy as it increases the risk of tearing, but also increases the incidence of fetal distress (see number 11.)
This isn’t to say that you will need an episiotomy if birthing laying down, only that you are more likely to than if birthing on all-fours or kneeling. The overall rate of episiotomy (in most Australian settings) is quite low, though this varies significantly between different countries.
4. More Painful
If you’re an avid ‘The Empowered Mama’ follower, you’ll know all about how oxytocin and endorphins promote easier labour, reduce pain naturally, and facilitate physiological birth. You’ll also know there a lot of things a Mama and her support person can do to ensure the flow of these magical hormones is protected.
Laying on a bed is not one of them, and for all the reasons mentioned in this article, it can, in fact, be detrimental to these feel good hormones making birth harder and more painful. Not to mention it sucks to sit on your tailbone while a baby is trying to move past it.
5. Instrumental Birth
A 2017 Cochrane review and meta-analysis (ie. a review of good research) found that women in a non-upright position for birth were 25% more likely to have an assisted instrumental birth with forceps of vacuum.
This could potentially be due to a longer pushing stage when on our backs and a higher incidence of carer-directed pushing when birthing supine – chin down, hold your breath and push! Causing less favourable fetal heart rate patterns, and higher incidence of intervention.
6. Pushing Uphill
Gravity is your friend when having a baby. I cannot emphasize enough how large a role it plays. All the twists and turns, head tucks and extensions your baby has to do to manoeuvre through the pelvis and into your arms is facilitated by being upright.
A woman’s pelvis is curved, not straight. When we see women left undisturbed and empowered to catch their own baby, they will instinctively pull baby along that curve up to their chest, not down to their feet. Because of this curve, if you’re birthing on your back, your body actually has to push baby uphill, making it a harder and longer process.
7. Longer Labour & Working Harder
Your uterus is incredible! It works hard to help baby find the optimal position and navigate through the pelvis, move down into the pelvis, and open the cervix. Then once bub is born, it separates the placenta from the inner lining and contracts to settle blood loss. How cool is that? But like anything to do with our body, we need to give it a bit of love so it can perform at it’s best.
We wouldn’t run a marathon without nourishing ourselves first. Let’s be honest, most of us wouldn’t run a marathon full stop. But the point is – laying on your back in labour doesn’t give your uterus the best chance.
Gravity isn’t helping it, baby is more likely to be posterior (‘back to back’), labour get’s drawn out, Mama gets fatigued and dehydrated and has to work harder, the uterus (being a muscle) needs hydration to work effectively. Contraction patterns become in-coordinate, and the snowball continues. In so many different ways – labouring on your back makes it longer and harder.
8. Cascade Of Intervention
Continuing on the snowball topic, we come to the next point – the cascade of intervention. This is a term we use in maternity care to describe a very real, known and proven pattern. Labouring on your back itself is not an intervention of course, but not having an upright active birth increases the likelihood of requiring an intervention, and that is where the snowball effect begins.
An example of a cascade of intervention might look like this:
A mother is restricted to the bed and unable to have an upright, active labour – labour becomes drawn out as baby is malpositioned/posterior – contractions become in-coordinate because of this and Mama is exhausted, Mama is given an intravenous drug to get the contractions established again so the cervix will dilate to a prescribed timeframe, an epidural is requested as her non-pharmacological pain relief options are limited stuck on the bed and augmented with synthetic oxytocin – the epidural requires continuous monitoring of baby, intravenous fluids, urinary catheter etc. – Mama is now completely unable to move to help jiggle her baby out of a non-optimal position – baby becomes distressed from the augmentation and epidural drugs – birth needs to be hastened with a vacuum/forceps as baby is distressed and needs to be born soon – this cascade can go on and on… distressing birth experience, poor bonding with baby, difficulty establishing breastfeeding, postnatal depression.
How we emerge on the other side of labour and birth matters. Physically and emotionally.
Intervention in maternity care has its place, and should certainly be used when appropriate. But what we know is that when intervention is overused, this in turn creates more problems.
Pharmacological pain relief methods, aka ‘drugs’, have their place and they are here to stay. Women should have options, and what’s important is that Mama’s make informed decisions about drugs, including the benefits, risks, and alternatives before going into labour.
For a Mama wanting a physiological birth, upright and active labour is more likely to facilitate this than laying down, which we know to be more uncomfortable and associated with increased use of drugs.
10. Bad Positioning Of Baby
A baby’s back will usually be encouraged into an optimal position for labour and birth, the front or side of Mama’s uterus, by way of gravity.
Ever been told not to lay on your back or slouch into sofas at the end of pregnancy? This is one of the reasons why.
When we lean forward on hands and knees, baby can turn into an optimal position and navigate their way through the pelvis much more efficiently. When we lay back, baby’s back is more likely to stay posterior, or turn from the side to the back.
Ask any Mama who’s had a posterior labour – it generally hurts more, there isn’t much relief from the sensations of labour in between surges, and it takes a lot longer.
11. Poorer Outcomes For Mum & Baby
Poor outcomes for Mama and bub are thought to be more common when recumbent during labour and birth for a few reasons. We’ve already covered a lot of them – bad positioning of baby, longer labour, interventions, mum and baby becoming distressed and so on. But what happens physiologically when we are on our back trying to birth… other than reducing the pelvic outlet size by 30%…
Laying on our back in labour increases the chance of vessels becoming constricted for mum by aortocaval compression causing low blood pressure, and for bub, by way of cord restriction. Both of these can cause reduced oxygenation to baby, fetal heart rate concerns, increased need for intervention – all leading to increased risk of poorer outcomes.
12. Loss Of Control
Labouring and birthing on your back leaves you more vulnerable to feeling a lack of control and leadership in your birth experience. Women have reported feeling they were ‘stuck’ to the bed and felt like they were pressured by their carers and ‘stood over’.
Even with a supportive and respectful carer, physically, it can feel very much like you’re stuck when laying down. When I laid down in labour for an examination (which I asked my Midwife for) I vividly remember feeling like a cockroach squirming on my back – no idea what to do with myself or how to help myself. Sooo not conducive to feeling positive and in control.
13. Negative Birth Experience
See all of the above. Need I say more?
Alternatives To Being On Your Back
Fortunately, there are many alternatives to being on your back in labour. Even if circumstances require you to lay down during birth, such as an epidural, a side lying position is a better option for maternal and fetal outcomes and perineal integrity.
A big step towards empowered birth is learning how different positions such as kneeling, squatting, lunging, walking can promote a better birth experience. You can practice at home! At the end of pregnancy, move around, be mindful of how open your pelvis feels, try different positions, and you’ll quickly learn what feels right for you. What is comfortable and what isn’t. Do this and you are well on your way to an active physiological birth.