Birth Positions: What Is Evidence Saying?

The labouring body most often constitutes a healthy, powerful body that has much more in common with the dancing, running, or erotic body than it does with the pathological body in need of cure and healing.
(Sara Cohen Shabot, 2015:233)

The pregnant, labouring, and birthing body is a strong and capable body. Hormones, muscles and bones work together instinctively to grow, birth and nourish a baby. However, this journey to motherhood has consistently become medicalised and the same routine intrapartum care applied to each birthing person. As observed by Dokmak et al. (2020:148), “hospital-based” intrapartum care is becoming “routine,” precipitating a shift away from physiologically based intrapartum care and trust in maternal-foetal anatomy and physiology, to the medicalisation thereof.

Medicalisation of pregnancy and birth means that pregnancy, labour and birth are viewed as pathological conditions in need of treatment, rather than normal physiology. This contributes to increased rates of interventions, such as episiotomies, instrumental births, and caesarean-section births that imply a loss of maternal autonomy (Fox et al., 2020; Zeynep et al., 2020:1874). One such contributing factor to the medicalisation of birth is the enforcement of supine or flat birthing positions.

Despite current evidence suggesting mobile and upright positions to be conducive to labour and birth, an overwhelming number of persons still labour and birth in immobile, flat positions, often with the idea that it is the safe norm. By permitting immobile and flat positions, a cycle of suboptimal outcomes is set in motion, the rights of birthing persons as outlined by the ICM are disregarded and evidence-based-information, numerous guidelines and studies stand ignored.

A Cochrane review showed that assuming a flat position during labour and birth has “adverse effects on uterine contractions”, which may hinder labour progress and in some cases, “reduce placental blood flow” (Lawrence et al., 2013:1). Further evidence suggests that in a lying position, contractions may be frequent, however not as effective as in an upright position (Huang et al., 2019:461). Furthermore, people who birth in supine positions are subject to negative birth experiences and unfavourable outcomes, such as severe perineal trauma, increased rates of Neonatal Intensive Care Unit (NICU) admissions (Huang et al., 2019:461) and a loss of autonomy (Mselle & Kohi, 2019:7), to name a few.

On the contrary, utilising mobile and upright positions has proven advantageous in many aspects of labour and birth, such as widening the pelvic dimensions and making use of gravity (Atsali & Russell, 2018:4; Garbelli, 2021:1) which facilitates foetal descent into and negotiation of the maternal pelvis. The duration of labour has been shown to be significantly shorter (Lawrence et al., 2013:2), maternal comfort enhanced and use of pharmacological pain relief methods reduced (Fox et al., 2020), all of which can result in a positive birth experience and outcomes for both a birthing person and baby (Dekker, 2018).

With the abundance of evidence, information and on-going research, (not to mention the gut-feelings and innate knowledge of people in labour), it seems the only approach to labour and birth is to advocate for and have complete trust in the foetal-maternal physiology.


Atsali E.N. & Russell, K. 2018. Hospital midwives’ barriers when facilitating upright positions
during a normal second stage of labour. Africa Journal of Nursing and Midwifery. 20(1), art.
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Dekker, R. 2018. The evidence on: birthing positions. Date of access: 03 Sep.2021.

Dokmak, F, Michalek,I.M, Boulvain,M, Desseauve, D. 2020. Squatting position in the second stage of labor: a systematic review and meta-analysis. European journal of Obstetrics & Gynecology and Reproductive biology.254:147-152. doi: 10.1016/j.ejogrb.2020.09.015

Fox, D., Maude, R., Coddington, R., Woodworth, R., Scarf, V., Watson, K., Foureur, M. 2020. The use of continuous foetal monitoring technologies that enable mobility in labour for women with complex pregnancies: A survey of Australian and New Zealand hospitals. Midwifery Journal, 93.

Garbelli, L., Lira, V.2021. Maternal positions during labor: Midwives’ knowledge and educational needs in northern Italy. European Journal of Midwifery.5(15):1-9. doi: 10.18332/ejm/136423

Huang, J, Zang, Y, Ren, L, Li, F, Lu, H. 2019. A review and comparison of common maternal positions during the second-stage of labor. International journal of nursing sciences. 6(4):460-467

Lawrence, A., Lewis, L., Hofmeyr, G.J., & Styles, G. 2013. Maternal positions and mobility during first stage labour. Cochrane database of systemic reviews. (10)1-125, art #CD003934. doi:10.1002/14651858.CD003934.pub4

Mselle, L.T., Kohi, T.W., Dol, J. 2019. Humanizing birth in Tanzania: a qualitative study on the (mis) treatment of women during childbirth from the perspective of mothers and fathers. BMC Pregnancy and Childbirth. 19(213): 2-11. doi:10.1186/s12884-019-2385-5

Shabot, S.C. 2015. making Loud Bodies ‘‘Feminine’’: A Feminist phenomenological Analysis of Obstetric Violence. Human studies: a journal for philosophy and social sciences. 39:231– 247.

Zeynep, D, Semra, E, Ciler, E, Didem, K, Meryem, E. 2020. Routine Interventions During Normal Birth: Women’s Birth Experiences and Expectations. International Journal of Caring sciences. 13(3):1868-1877.

Post Credit

Natalie du Trevou – graduated student from CSMC ’23.