Birth Positions:
Lithotomy Position (Lying Down)

The lithotomy positon is one of the most common birth positions, especially in hospitals as it is one of the easiest positions to assume if you have an epidural. There is another horizontal position which is called the side-lying or left-lateral position which is possibly a better option if you have an epidural.

Something that bugged me when I was doing research for this series on birth positions was that the only stock images I could get were of women laboring and giving birth in lithotomy position, and you may have noticed that whenever you see a woman giving birth on TV, it's on her back or semi-sitting. Even in most childbirth reality shows women seem to be on their backs or semi-sitting most of the time.

...we assume that the lithotomy position is used because it has been proven to be the best for mom and baby, although that couldn't be further from the truth

So that's how we assume women are to give birth, and we assume that this position is used because it has been proven to be the best for mom and baby, but what's crazy is that the lithotomy position is the worst position for natural birth, but it is still the most widely used in many hospitals. I know I sound more than a little biased, but read on and you might see why.

Make sure you read all the advantages and disadvantages of the lithotomy position so you know to avoid it as far as possible!

Birth Position: Lying down / Lithotomy Position / Supine

Description:

Lying flat on your back or on a slight incline, sometimes with legs in stirrups.

lithotomy positionlithotomy position with stirrups
Lithotomy PositionLithotomy Position with Stirrups

Advantages:

  • None whatsoever other than the fact that it won't interfere with the catheter, IV line, epidural catheter or internal monitor.
  • The Lithotomy position often one of the few positions you can adopt if you have an epidural.

Disadvantages:

  • Lithotomy position is more painful than other positions. (1, 2)
  • Easy access to perineum. (Staff often see this as an advantage, but if you're wanting to avoid an episiotomy (or even avoid tearing) it can be a disadvantage.)
  • Doesn't help labour at all.
  • Results in the narrowest pelvic opening and places pressure on the tailbone (coccyx).
  • Forces the mother to push against gravity. Essentially she has to push 'uphill' and this increases the length of the pushing stage.
  • Increases the pressure on the perineum which increases tearing and episiotomy rates, especially compared to squatting. (3, 4, 5, 6)
  • The woman's movement is restricted thus increasing the length of labour. (7, 8)
  • It increases the risk of forceps or vacuum delivery. (9, 10, 11)
  • Pushing in the lithotomy position increases your chances of having an episiotomy. (12)
  • It places pressure on blood vessels leading to the uterus and can limit blood flow to the baby. (13, 14, 15, 16) This may decrease the baby's heart rate which causes your caregiver to want to monitor you more closely which restricts your movement even more.
  • It increases the risk of the baby being in a bad position (malpresentation) by putting more 'hurdles' in the way (the coccyx for one).
  • It increases the risk of shoulder dystocia (where one or both shoulders get stuck) because of the decreased size and shape of the pelvis.

In short: 'Except for being hanged by the feet, the supine position is the worst conceivable position for labor and delivery.' Dr. Roberto Caldeyro-Barcia. Past president of the International Federation of Obstetricians and Gynaecologists. (17)

For something a little better, check out the pages listed in the box to the right of this paragraph.

References:

1. De Jonge A, Teunissen TA, & Lagro-Janssen AL. 2004. Supine position compared to other positions during the second stage of labor: a meta-analytic review. Journal of Psychosomatic Obstetrics & Gynecology. 25(1):35-45. Back.

2. Gupta JK, & Hofmeyr GJ. 2004. Position for women during second stage of labour. Cochrane Database Syst Rev. 2004(1):CD002006. Back.

3. Terry RR, Westcott J, O'Shea L, & Kelly F. 2006. Postpartum outcomes in supine delivery by physicians vs nonsupine delivery by midwives. Journal of the American Osteopathic Association. 106(4):199-202. Back.

4. Nasir A, Korejo R, & Noorani KJ. 2007. Child birth in squatting position. Journal of the Pakistan Medical Association. 57(1):19-22. Back.

5. Golay J, Vedam S, & Sorger L. 1993. The squatting position for the second stage of labor: effects on labor and on maternal and fetal well-being. Birth. 20(2):73-8. Back.

6. Bhardwaj, N, Kukade, JA, Patil, S, & Bhardwaj, S. 1995. Randomised controlled trial on modified squatting position of delivery. Indian Journal of Maternal and Child Health. 6(2):33-39. Back.

7. Allahbadia GN, & Vaidya PR. 1993. Squatting position for delivery. Journal of the Indian Medical Association. 91(1):13-16. Back.

8. Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, & Styles C. 2009. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 15(2):CD003934. Back.

9. Roberts CL, Algert CS, Cameron CA, & Torvaldsen S. 2005. A meta-analysis of upright positions in the second stage to reduce instrumental deliveries in women with epidural analgesia. Acta obstetricia et gynecologica Scandinavica. 84(8):794-8. Back.

10. De Jonge A, Teunissen TA, & Lagro-Janssen AL. 2004. 2004. Supine position compared to other positions during the second stage of labor: a meta-analytic review. Journal of Psychosomatic Obstetrics & Gynecology. 25(1):35-45.Back.

11. Nasir A, Korejo R, Noorani KJ. 2007. Child birth in squatting position. Journal of the Pakistan Medical Association. 57(1):19-22. Back.

12. Bodner-Adler B, Bodner K, Kimberger O, Lozanov P, Husslein P, & Mayerhofer K. 2003. Women's position during labour: influence on maternal and neonatal outcome. Wien Klin Wochenschr. Oct 31;115(19-20):720-3. Back.

13. Kerr MG, Scott DB, Samuel E. 1964. Studies of the inferior vena cava in late pregnancy. British Medical Journal. 1:532–3. Back.

14. Clark SL, Cotton DB, Pivarnik JM, et al. 1991. Position change and central hemodynamic profile during normal third-trimester pregnancy and post-partum. American Journal of Obstetrics and Gynecology. 164: 883–7. Back.

15. Danilenko-Dixon DR, Tefft L, Cohen RA, et al. Positional effects on maternal cardiac output during labor with epidural analgesia. American Journal of Obstetrics and Gynecology. 175: 867–72. Back.

16. Chen, GY, Kuo, CD, Yang, MJ, Lo, HM, & Tsai, YS. 1999. Comparison of supine and upright positions on autonomic nervous activity in late pregnancy: the role of aortocaval compression. Anaesthesia. 54(3):215-219. Back.

17. Caldeyro-Barcia, R. qtd in O'Mara, P, Facciolo, J, and Ponte, W. 2003. Mothering Magazine's Having a Baby, Naturally: The Mothering Magazine Guide to Pregnancy and Childbirth. Simon and Schuster. Back.

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