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Q & A: Do I have to push on my back?

Q. During my first birth, my OB insisted that I lay on my back during the pushing phase of labor even though my baby and I were doing fine. Pushing on my back was painful and didn’t feel right to me. Do I have to give birth lying on my back?

A. No. In the absence of true complication, you should be supported in choosing a pushing position that feels right for you. Your instincts were good in choosing a position other than lying on your back. Positions that work with gravity and allow maximum pelvic expansion are known to result in better outcomes for birthing people and babies – We practice these positions in the birth classes I teach because they can contribute to a more comfortable and efficient birth. The benefits of these positions have been observed time and time again by those who are experienced in supporting physiologic birth, and they are also well represented in research and in the opinion of professional organizations related to birth.

A 2017 Cochrane Review found that birthing people using upright pushing positions in the second stage of labor were 25% less likely to have a forceps or vacuum-assisted birth, 25% less likely to have an episiotomy, and 54% less likely to have abnormal fetal heart rate patterns. Further, the American College of Obstetricians & Gynecologists stated in 2017 that for most people, “no one position needs to be mandated or prescribed” and the statement went on to recognize that many providers encourage a supine position despite known adverse effects (ex. Low maternal blood pressure, more frequent abnormal fetal heart tones). The American College of Nurse Midwives (ACNM), the Royal College of Midwives (RCM), and the World Health Organization (WHO) have all voiced support for encouraging women in their choice of birthing position, using active and upright positions, and avoiding supine positions.

During pregnancy, I encourage you to discuss your preference for upright birthing positions (and any other birth preferences) with your chosen care provider, as well as any other provider who may attend your birth. Pay attention to their reactions and their responses. Do you feel confident that they will provide evidence-based care that is also supportive and respectful? Treat your appointments like interviews in which you are searching for the right candidate for the job. If you find that your provider(s) is not a good fit, please don’t hesitate to move on to another candidate! There are many provider options in our area to choose from who provide care for birth in the hospital, at home, or at a birth center.

Wonderfully Made Birth Services offers birth classes, workshops, and private birth planning consultations to help families recognize and connect with evidence-based care, discover their birthing options, learn specific techniques for a more comfortable and efficient birth, and become empowered to advocate for themselves and their babies. Please reach out – I’d love to help you prepare for your birth!


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