Research Nerd Alert!
A 2017 Cochrane Review and Meta-Analysis (ie. the HIGHEST level of research evidence available) studied birth outcomes for over 9000 women delivering in lying positions (semi lying, lithotomy, semi sitting), vs upright positions (birthing stool or cushion, kneeling, hands-and-knees, and squatting). *Note – these were women who DID NOT have epidurals.
What were the findings? Women who delivered in upright positions were:
  • 25% less likely to have a forceps or vacuum-assisted birth
  • 25% less likely to have an episiotomy
  • 54% less likely to have abnormal fetal heart rate patterns
  • 20% more likely to have a second-degree tear; the absolute risk was 15.3% for people in upright positions vs. 12.7% for those in supine positions
  • 48% more likely to have estimated blood loss greater than 500 mL; the absolute risk was 6.5% for people in upright positions vs. 4.4% for those in supine positions
  • 3 out of 4 of the studies measured pain and found that upright positions decreased pain rating during pushing phase as well.

This all makes so much sense when you understand the anatomy and physiology of the birthing pelvis. Freedom to move, freedom for the pelvis to expand, and ability of the pelvic floor muscles to gradually stretch as baby emerges – all possible when you assume upright positions for birth.

Check out this in depth article from Evidence Based Birth for even more details about birth positions. The whole website is fantastic and highly recommended.