Former tokophobia sufferer, mother of two fearless births, author of Betrayed By Your Biology and Fearless Birthing.
Picture giving birth and most people see the same image: a woman flat on her back, feet in stirrups. We treat it as the natural, default way to have a baby. It is nothing of the sort. Giving birth on your back is arguably the worst position you can be in, and the reason it became standard has nothing to do with what is good for women.
Where giving birth on your back came from
There is no scientific basis for birthing on your back. The story goes that it traces back to Louis XIV, the French king, who wanted to watch women give birth and found it easier to see with the woman lying down. A position adopted for a king’s convenience somehow became the default in maternity wards across the world. It deserves to be questioned far more than it is.
Why it works against you and your baby
Lying on your back during labour creates real, physical problems. It can reduce blood flow, which is not what you or your baby want. It tends to increase pain. It arches your back awkwardly. And perhaps most importantly, it makes your baby work against gravity rather than with it, when gravity is one of the most useful allies you have in birth.
Upright, active positions do the opposite. Squatting, standing, kneeling, being on your side, or simply moving and walking around all let gravity help, keep things open, and tend to make labour more comfortable and more efficient. Your body knows how to do this when you let it move.
How to claim the freedom to move
Knowing this is one thing, feeling free to do it on the day is another, especially in a hospital setting where the bed is right there and the default pull is strong. This is where preparation and advocacy matter. Decide in advance that you want to stay active and upright, put it in your birth plan, and make sure your birth partner knows to support and protect that for you.
This is part of the bigger principle of choosing your birth: understanding your options so that you, not habit or convenience, decide how you birth. The free 9 Steps of Birth Prep and the Birth Prep Classes help you prepare to birth actively and on your terms.
Frequently asked questions
Is it bad to give birth on your back?
Giving birth on your back is generally the least helpful position. It can reduce blood flow, increase pain, arch your back, and make your baby work against gravity. There is no scientific basis for it as a default, and upright, active positions tend to be more comfortable and more efficient.
Why do hospitals have women give birth on their backs?
Largely habit and convenience rather than evidence. The position is widely thought to trace back to Louis XIV wanting to watch births, and it stuck because it suits attendants, not because it suits the woman or baby. You are entitled to question it and choose differently.
What is the best position to give birth in?
There is no single best position, but upright and active ones, squatting, standing, kneeling, on your side, or moving around, generally work with gravity and tend to be more comfortable and efficient than lying on your back. The best position is one your body chooses as you move freely.
How do I make sure I can move during labour?
Decide in advance that you want to stay upright and active, write it into your birth plan, and brief your birth partner to advocate for it. Preparation and a clear, supported plan are what let you claim the freedom to move, even in a hospital where the default is the bed.
About the author: Alexia Leachman believes real birth preparation starts with what is going on inside you, not just the breathing techniques and the birth ball. After years of tokophobia she prepared for and had two fearless births, and wrote Fearless Birthing to help women get ready emotionally as well as practically. More about Alexia →
This is general information, not medical advice. Discuss birth positions and any health considerations with your own midwife or care provider.
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