Think of the last movie or tv programme you watched where a woman gave birth. You most probably saw her on her back. Legs up. Screaming at a Doctor dressed in scrubs…. Maybe something a little like this.
This position is more commonly known as ‘Lithotomy’. This position does have a place in some situations, however in a birthing environment it is most often suggested to ensure physician comfort. Not mothers comfort.
I used to work with a Doctor who had a ‘sore back’. Yeah, you and nearly every other healthcare professional out there love! And she would try and force women off the ball, stool, floor, pool and on to the bed in to the lithotomy position so she didn’t have to bend. She used to ask us to do this as midwives for her. You can imagine how many times I did that for her……..
Lithotomy positioning is the favoured position because it is easier for the attendant to access the birth canal and perineum, and take care of any complications that may arise. Yet complications can arise from being in a position such as this, as it narrows the outlet of your pelvis. Coincidence? I think not….
One of the massive differences between Doctors and Midwives arises here. If you are not on a bed, but you are squatting in the corner, midwives are the ones who hike up their sexy scrubs, kneel down on a pillow and help you birth your baby where you are. We do it in any position… (Sorry but I love a bit of innuendo).
Lithotomy position is more commonly referred to as the “stirrups”. I hate that reference. I mean we are women. Not horses. It originated from a medical procedure called lithotomy which is actually a procedure to remove kidney and bladder stones. So that would be NOTHING to do with birthing a baby at all then.
What is lithotomy position?
It involves lying on your back with your legs flexed 90 degrees at your hips. Your knees will be bent at 70 to 90 degrees, and padded foot rests attached to the table will support your legs.
So let’s think for a minute about the anatomy of the pelvis and how that is affected in this position.
The female pelvis usually has a slight anterior tilt (meaning it tips slightly forward), especially in pregnancy.
The sacrum (The bit at the back known as your tailbone or coccyx) moves back during delivery to make the space of your pelvis outlet bigger. Which is a great thing if you need to push a 7lb tiny human out of your vagina.
Lithotomy position in anticipation of a 'big baby'is stupid. It is just physics. All fours allows a bigger space to deliver baby through.
When in the dorsal lithotomy position, a woman is putting direct pressure on her sacrum (tailbone) which forces it into a flexed position and making the pelvic outlet smaller. This can reduce the size of your pelvic outlet by up to one third!
Also, when in this position, the curve of your pelvis has an “uphill” orientation, forcing the mother to have to push the baby against gravity through an increasingly narrowed space.
Here is a really good youtube video that shows just how the baby and pelvis move during birth of the baby:
Watch the tailbone during the birth of the baby and now imagine the this in an upright position. Makes much more sense no?
When is the right time for lithotomy position?
Like I said, it has a place. It is really useful in the following circumstances:
If you need a forceps or ventouse delivery – this allows the doctor better access and more control of the instruments. This is essential.
If you have a heavy epidural – Sometimes you can have a very dense epidural and you end up with legs you cannot control by yourself. Whilst for pushing I would realistically expect your Midwife or Doctor to adjust the amount to ensure this resolves, it is not always the case. We do not want you to have a leg fall off the bed as that can cause injury. Also supporting your legs in this way can help focus your pushing if you have reduced sensation.
If it is comfortable – Some women enjoy the support they have from the lithotomy poles. If it I comfortable for you then by all means do it. But bear in mind that this can hinder pushing! Instead try being on your side and having one leg up in the lithotomy pole. Swapping from right side to left side.
If you need an FBS – An FBS (Fetal Blood Sample) is a sample of blood taken from your baby’s scalp. This is usually done with your leg in one lithotomy pole whilst lying on your left side but can be done in full lithotomy too.
ARM – Artificial Rupture of Membranes…. Aka breaking your waters. Some times this is done in lithotomy position because your cervix is not as far forward as in established labour.
Stitches – If you need stiches after delivery then this position is best for you to be in. It gives us the best access and the best visibility and let’s be honest, if we are stitching you back together then you want us to have the best working conditions!
Ultrasound – If you need a trans vaginal ultrasound scan (the long wand that looks like a large medical dildo) then you need your legs in this position to allow the Doctor to scan correctly.
Gynaecological Procedures – I personally do not get a smear test with my legs in lithotomy. But if you are having some gynae procedures you may need to have them done in this position.
What positions are better for delivering your baby?
Literally any position you damn well want. Sitting on a stool. Standing. Squatting. In the pool. In the bath. On all 4’s. Leaning over the bed. Leaning against your partner. One leg up on a chair or bed. However you feel comfortable (As comfortable as you can be with a baby coming out your lady parts). Assume that position and unless medically indicated, we will work around you!
So if your Doctor advises you use the lithotomy position but there are no safety concerns and you are comfortable as you are, then politely tell them to do one and stay in whatever position you think is allowing you to birth your baby best.
If they recommend you do this so they can safely assist the delivery of your baby due to concerns in your labour then please get those legs up!
Remember it is your birth and your body. Choose what is best for you and if advised to do otherwise make sure there is an explanation and consent. Don't put a Doctor's comfort above your own. They are not the ones trying to poo out a tiny human!