Why Do Women Give Birth Lying Down

The human birth process is a complex one involving many organs and functions of the body. The most important function in this process is movement of the uterus from its contracted state (the cervix opens) to an expanded state where the child can be delivered. This transition requires energy expenditure by the body and thus requires oxygen for fuel. The brain signals the muscles involved in childbirth to contract to expel the baby through the vagina. Once the head emerges, the muscles are stimulated with powerful contractions called ‘efforts’ until the shoulders emerge. These efforts continue after delivery of the rest of the body. In between each effort there is a short period of relaxation known as the latent phase. It takes about 30 minutes for the second contraction to occur following the first one. After all the other parts of the body have been expelled, the final part of the birth – pushing — begins. During this part of the process, the uterus contracts strongly enough to deliver the placenta. The whole process takes around 2 hours.
There are several positions which help facilitate different stages of labour. However, not all women find themselves comfortable or able to assume any one specific position during labour. There are some positions which are recommended specifically for certain types of labours such as breech births or when the woman’s pelvis is smaller than normal.
In general, women who experience slow labours usually prefer to sit upright on their beds. Some women may choose to lie down later but only if they are still feeling well and do not need to use the toilet. If you are lying down however, make sure that your back remains straight and support your legs on pillows or cushions.
Some people believe that lying down in a particular position helps them to relax more during the stage of pushing. Others say that lying down makes the process faster and easier. But what is the truth? Is positioning yourself while giving birth really necessary?
Lying down has become common practice even though there isn’t much evidence to prove whether this actually helps. Most of the midwives believed that the supine position benefits the foetus, mother, and the midwife. They also believed that supine was beneficial to the mother as it made her feel relaxed and allowed her to easily push the baby out because it conserved her strength.
On the other hand, doctors often suggest the prone position for mothers-to-be who have difficult labours due to multiple pregnancies. Doctors consider that the prone position allows easy access for examination and intervention.
A study conducted at the University Hospital Gasthuisberg in Belgium showed that neither position had any significant effect on the duration of active pushing. Although babies born in the prone position were less likely to require resuscitation, they required more medical interventions overall. Babies born in the supine position were more likely to die before hospital discharge and those that survived needed fewer days in neonatal intensive care units. The researchers concluded that although both positions seemed safe, the prone position resulted in better outcomes.
So what does the research show? Does lying down help or hurt? Here are some answers…
1. A 1999 review published in CMAJ found no difference in the rate of successful vaginal births between women lying down compared to sitting up; rates ranged from 86% to 94%. Furthermore, no differences were seen in the incidence of shoulder dystocia or obstetric anal sphincter injuries. While these findings seem encouraging, caution must be used when interpreting the results since the authors did not take into account the type of birthing centre (i.e., level 1 versus level 3). Level 1 centres provide high quality maternity services including 24 hour availability of staff members whereas level 3 centres are staffed mainly by student midwives.
2. Another review published in 2005 in JOGC highlighted similar results. The authors of this review looked at 14 studies and 11 clinical trials comparing two groups of pregnant women: one group received instruction in how to change to a new position and another group did not receive any instructions. The authors found that there was insufficient data to determine whether changing from the supine to the prone position affected the chance of cesarean section, instrumental or operative deliveries, or postpartum hemorrhage. However, they noted that the prone position appeared to be associated with a lower risk of fetal distress and shoulder dystocia.
3. A 2008 study examined the effects of maternal position on newborns. Researchers studied 13,879 low-risk women in spontaneous labor over a six month period. Of these women, 6,943 were randomly assigned either the lateral decubitus (lying on side), sitting upright, or the lithotomy (on their backs) position. No differences were observed among the three groups regarding mode of delivery, Apgar score at five minutes, episiotomy rate, or perineal trauma. Researchers concluded that the supine and sitting upright positions appear to be equally effective.
4. The American College of Obstetricians and Gynecologists recommends that women give birth in the supine position if possible. When a woman needs to move to the prone position, she should be turned slightly on her left side so that gravity assists with pushing. The ACOG states that “lateral recumbency” is preferred for nulliparous women without prolonged pregnancy (more than 42 weeks gestation) or twin gestations. For primigravidas, the ACOG recommends that the mother remain in the supine position unless she becomes uncomfortable or unable to tolerate the upright position.
5. The Society of Obstetricians and Gynaecologists of Canada recommends the same position for all women except those in whom it poses risks. Risks include severe preeclampsia, eclampsia, placental abruption, abruptio placentae, and uterine rupture.
6. The Royal Australian College of General Practitioners suggests that women avoid moving to the prone position unless absolutely necessary. Prone is particularly dangerous for women with twins. Other risks include difficulty in intubation and pulmonary aspiration.
7. The World Health Organization advises against using the prone position for routine caesareans. Since the procedure can cause serious damage to the lungs and airways, WHO recommends that the operation be done in the vertical rather than the horizontal position.
8. The British Medical Association considers the prone position unsafe for caesareans. The BMA believes that the safest way to perform a caesarean is with the patient in the supine position.
9. The International Liaison Committee on Resuscitation guidelines recommend avoiding the prone position during cardiopulmonary resusc.
10. The American Academy of Pediatrics discourages the use of the prone position for infants under four months old. The AAP notes that the prone position increases the risk of apnea, bradycardia, hypoxemia, hypercapnia, acidosis, coagulation problems, airway obstruction, chest compression injury, and skin breakdown.
11. The American Congress of Obstetricians and Gynecologists warns against the use of the prone position during surgery. According to the organization, the position puts pressure on the abdomen and causes blood loss.
12. The American College of Surgeons concludes that the prone position is contraindicated in patients with unstable fractures, dislocations, ruptured discs, acute appendicitis, massive ascites, abdominal tumors, urinary incontinence, or meningocele.

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