Lithotomy Position for Giving Birth: a.k.a. the Stranded Beetle

The lithotomy position is the worst position for giving birth (except for maybe standing on your head).

This flat-on-the-back position is probably how you picture a woman giving birth. She is on her back with her legs up in the air spread apart in stirrups or being held up by her birth companions. It is bad for the mother and bad for the baby.

Then why is it used?

Oh that's riiight...its convenient for the doctor. The lithotomy position gives the doctor a good vantage point from which to conduct his (or her) business. It provides easy access for cutting an episiotomy, for using forceps or vacuum extractor, and for doing vaginal exams.

The bad thing about the lithotomy position is:

  • lying on your back puts pressure on the vena cava which is bad for both you and your baby. It reduces blood flow and therefore oxygen to both you and your baby. It can lead to fetal distress.

  • It decreases the diameter of your pelvis by as much as an inch.

  • It is uncomfortable. It can even cause contractions to be more painful. Most women if given the option do not lie on their back during labor and birth.

  • In this position you are pushing against gravity. Because of the unique contours of the birth canal you are actually pushing uphill in the lithotomy position. During birth you want to get gravity to work for you. This means that in almost all cases you want to be as upright as possible so the baby can come down.

  • The lithotomy position can make you feel like a stranded beetle. You really don't have much control in this position. It can be hard to hold or grab onto anything and the stirrups or attendant's arms aren't as sturdy as a solid surface underneath you.

  • This is the position used for pelvic exams which might not be the association you want when you're giving birth. It exposes all of your parts to everyone else present. Laboring and giving birth in upright positions faces your yoni/vagina/private parts to the floor.

  • Because of the lack of control in the lithotomy position and possible association with sexual abuse it could be an especially troublesome position for sexual abuse survivors.

  • It puts strain on the perineum and in combination with forcible pushing makes perineal tears more likely to occur.

Semi Lithotomy or Semi-Reclined Position

This position has become as popular as the lithotomy position. In this position the laboring woman is semi-reclined and sitting back on the hospital bed with people holding her legs up and pushing them back. Stirrups are sometimes used or the woman holds her own legs back as she pushes.

It is just as bad as the full lithotomy position. When semi-reclined you are sitting on your tailbone and sacrum and it does not allow the pelvis maximum mobility. It creates a smaller pelvic diameter. A smaller pelvic diameter is not something you want when you are pushing a baby through your pelvis!

The semi-reclining position might have to be used if you have an epidural and don't have full use of your legs. Even so, sometimes you can be helped into a more upright position by others and/or be able to use a squat bar attached to the hospital bed.

Better Positions For Giving Birth

  • Squatting

  • Standing squat

  • On hands and knees

  • Kneeling

  • Side-lying

  • Sitting on the edge of a bed, chair, or birthing stool

The Advantages of Upright Positions

  • Increases the diameter of the pelvic outlet

  • more comfortable

  • Strengthens contractions

  • helps baby to rotate and move into the optimal position for being born

  • keeps the blood and oxygen flowing to you and your baby

  • being upright makes use of gravity

  • give you greater control

  • the baby's head is directly on the cervix so it actually helps with cervix dilation.

  • less tension on the perineum, so in combination with slowly easing baby out it can make for minimal or no perineal tearing.

  • easier for you to guide your baby into the world with your hands and bring him right up to you

We have to get over this idea that a woman giving birth is somehow sick, weak, or needs to be rescued. A woman in labor DOES NOT need to be in bed lying down!

Labor and birth is hard work. A woman giving birth needs to be active, not passive. Stay upright, mobile, and change position often.

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