Don’t Lie Down: Birthing On your Back and the Worst Case Scenario

I speak from experience that moms are often checked in, set up in the bed and hooked up to monitors. Many uniformed moms end up staying there throughout the rest of their labor. Granted some maybe walked the halls once or twice, or gotten up to go to the bathroom, but then end up back in the bed, hooked up to monitors.

As a doula, my job requires me to tell the truth, to give you pros and cons, so here it is. While there are times to lie down and rest, the worst position is to be horizontal. Why is that? You are working against gravity.

“Well, that is where the nurse put me to monitor the baby”. For future reference, this monitors can be put on you, while you are in different positions. You could be on your side, on a ball on the floor, or even in water. They often have portable monitors that can go where you go.

Most hospital policies only require 20 minutes of fetal monitoring every hour. When my clients are being monitored, we watch the time and immediately unhook when the 20 minutes are up. I usually give the nurse a heads up that we will do so. Then we are up, moving around again. If you have a midwife, there are often fewer, non-invasive monitoring going on. Usially they just monitor thru a contraction, to see how baby is during and after the contraction.

So why is laying on your back such a problem? First of all, your pelvis is compacted down to the smallest space, the “hot dog space”, I call it. Lying on your back decreases your pelvis by 30%.  If you turn to one side, you are opening up a bit more to an egg-shaped pelvis, as you are widening the side closest to the bed. Oftentimes, by having a doula put pelvic/hip pressure on the other hip, you are widening it to a circular shape. If in any other position, you are causing less cramming of your pelvis, allowing baby to move freer.

Other reasons are that is restricts blood-flow and can also lead to harder births, because you are pushing uphill and against gravity, causing your efforts to not work efficiently. These moms often have longer labors and require more interventions.

When moms are less comofortable, it increases intensity of each contraction. Her hips becomes sore, her tailbone numb, and she will begin to sense more activity, because she isn’t moving with the pain. Moving while contracting, especially before pushing, can help destract mom from some discomfort and pain. As she builds a rythm, she can often manage her hips and pelvis into an ideal position. With techniques, such as the double-hip squeeze, mom’s pelvis can open to a more rounded optimal position.


(Me doing double-hip sqeeze on laboring mom. She is leaning over a counter).

Ideally, squatting is a wonderful position, or even semi-sitting or side-lying, while bringing legs up to the body. During the pushing stage, if you can get your legs toward you chin, the better the outcome. Even getting one leg up, can make all the difference. If you must do some side-lying, I recommend putting  a few pillows under your head, to create some incline, as well as putting a few pillows or a small peanut ball between your legs. Anything to open the pelvis is most beneficial.

A common question may be “What if I get an epidural”? There is still hope in a shorter birth, if you practice having an incline of your head, sitting upright or side-lying. Believe it or not, you can still maneuver to a squatting position with an epidural.

Here are a couple suggestions that can be used with or without an epidural. Have the staff help you into a sitting position, dropping the bed bottom down (for hospital births). Have them put up the birth bar. You can use that for leaverage. Even using a sheet or rebozo to pull up on can help get you into a squat. Another favorite is having the staff help you turn around on your bed, raising the head up really high, and leaning up over the bed. These optimal pushing positions will encourage gravity to work in your favor.

Overall, the worst-case senario is feeling trapped in your bed or even worse yet, not moving throughout your labor. These labors are far more dangerous and may lead to interventions and possibly a cesarean, as the numbers go up with moms not being aware of positioning for baby in the pelvis. Why do I say dangerous? I always go back to the Fear-Tension-Pain Cycle.


The more fear a mom has, because things might not be progressing well, the more pain and tension she holds. The more tension on her causes muscles to tense up, narrowing the pelvic floor outlet for baby.   To avoid these disruptions in labor, move frequently, get into upright, gravity-loving positions. I assure you, labor will go smoother than sitting in a bed.

For more information, please research to make an informed decision to not birth on your back. Hire a doula, as she is great at recommending the right position at the right time.

Written by Tina Black @ Doula💜


10 Reasons To Not Give Birth On Your Back


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