Position, and why lying on your back is the default
It suits the room, not the birth.
Across 30 trials and 9,015 women without an epidural, being upright rather than on your back in the second stage produced fewer assisted deliveries (relative risk 0.75), fewer episiotomies (relative risk 0.75) and a slightly shorter second stage. It also produced possibly more second-degree tears (relative risk 1.20) and more blood loss over 500 mL (relative risk 1.48).
So it is a trade, not a clean win. But note that the default position in most American hospitals, on your back with your legs up, is the one that produced more instrumental deliveries and more episiotomies, and it is chosen largely because it gives the clinician the best view and access.
Even with an epiduralYou can usually be helped onto your side, or upright with the bed raised. Ask. A modern low-dose epidural rarely requires lying flat on your back.
Where this comes from:
201. Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2017;(5):CD002006.
202. Walker KF, Kibuka M, Thornton JG, Jones NW. Maternal position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev. 2018;(11):CD008070.
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This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.