The most consistent piece of advice that people hear during their pregnancy is,
“Don’t push on your back! It’s the worst position to push in!”
Photo Used Under Creative Commons Licensing.
Women frequently tell us this in their prenatal appointments. They write it in their birth plans. They have read it on websites and heard it from friends. They are TERRIFIED of pushing on their back and what that will mean.
First, let’s take a look at the myths:
MYTH 1: Pushing on your back takes longer
The idea behind this myth is that because the baby needs to move under the pubic bone, then up, it takes longer to push your baby out because there is more work to be done. However, studies don’t bear this up. They show that there is no difference in how long a person pushes for, regardless of whether they push upright or lying down.
MYTH 2: You have to push flat on your back
Pushing flat on your back, or the lithotomy position, is actually not the norm. This position typically involves the birthing person putting their feet and calves in stirrups, with the top half of the bed completely flat. The person cannot see the end of the bed, except with great difficulty. While there are certain instances where this position is useful, particularly shoulder dystocia in women with an epidural, it is rarely used.
MYTH 3: Doctors use this position solely to benefit themselves
While there are certain advantages for care provides to this position, to suggest that is the ONLY reason it is used is to suggest that doctors do not care about the health, safety, or comfort of their patients at all. And we know that simply is not true.
The reality is, the position they most people are thinking of when they say, “I don’t want to push on my back!”, is the semi-reclined, or “throne” position. Well, we are going to reclaim that throne! Pushing in a semi-reclined position has some wonderful advantages for birthing person and it is time we saw it as the pushing position of power that it is.
REALITY 1: Many people find the position helpful
Sitting semi-reclined and drawing back on the legs is a very familiar position for pushing. It is the most common position suggested, we are exposed to it in the media, and many others who have given birth discuss pushing this way. This can make is easier to focus on pushing.
REALITY 2: You can rest between pushing
If the back of the bed is raised to create your “throne”, you can easily lean back and rest between contractions. It’s even possible to doze between them! These short rests can help give you the energy to push longer, something that is especially important if this is your first baby and it takes longer to figure our the right muscles to use.
REALITY 3: It IS easier for care providers, and that isn’t a bad thing
Your medical care team are not there to ruin your birthing experience, their job is to protect the health and safety of parent and baby. So if they need to have clear access to your baby, or a clear reading on the monitors, something that is very difficult in other pushing positions, their focus in that moment is on their job. It can also be safer for those who have had an epidural.
REALITY 4: This is actually a great position to push in!
Pulling back on the legs, or pulling on hands or a sheet attached to a squat bar can help direct all your pushing energy down and out. Which is exactly where your baby needs to go! The resistance created by pulling back on the legs is extremely helpful to many people.
We believe that you should push in whatever position calls to you and feels right! We will help you to push on all fours, while squatting, on your side, or, on your back!
Many advocates against pushing in reclined or semi-reclined positions argue that this position narrows the pelvic inlet, making it harder to push. From a physical anatomy perspective, the pelvis does narrow due to pressure on the sacrum (tailbone). However, if your pushes are more effective because this is the position you are able to push best in, that narrowing doesn’t make a difference.
Instead of demonizing the throne position, lets reclaim it! It is your throne! It is a position of power as you give birth and bring your baby into the world.