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In another thread I read a number of posts describing how lying flat on your back allows your pelvis to open, and that it's similar to a squat just without the aid of gravity. REALLY?!? I'm amazed to learn this. All these years I have heard that lithotomy (flat on back with legs in the air) is the worst position ever, it's awful, horrible, evil, no one should ever give birth in it. Now I am hearing that it's not so bad?<br><br>
Please, someone set me straight. I am so confused now. I have been convinced for 3 years now that my son's passage out of my body was blocked because I was on my back and pressure was on my tailbone, making him bounce off my pelvis. But if lithotomy actually OPENS your pelvis, then maybe that's not even true. What am I supposed to believe here?
 

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My understanding is that the best thing is for the laboring woman to be able to move around and find the best position for her at that time. Any time you have medical professionals limiting or directing the birthing woman's position, you can have problems developing.
 

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so between the 2 sitting or laying flat down - legs being held by mom rotated up so it looks like a lying squat(not in leg holders) can be better than sitting because sitting does put pressure on the coccyx and sacrum and actually covers the outlet a bit -- especially in reference to getting a baby through that is dipping and popping out of the pelvis or with a shoulder dystocia -- not that a mother's position should be static - and she should be able to move in the position that works for her-- before instruments come out- or other crap-- any how the thing is that on your back is not the best position for everyone and has a limited usefullness but is still useful in some cases-- just keep it in mind and also think that it may not have been right for you at the time
 

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If a woman has a heavy epidural and some of the more upright positions aren't an option, pushing in lithotomy can open the pelvis more than semi-Fowlers (propped up). However, pushing in a side-lying position is probably a better idea.<br><br><br>
ETA - mwherbs and I posted at the same time, but that is basically what I was saying.
 

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I went unmedicated and the position I *chose* freely to give birth in was lying on my back. The midwife was encouraging me to move to other positions but it was the only one that felt right. I tried hands and knees, sitting, squatting, but I didn't want anything to do with any of them. They felt wrong; lying down felt right. *shrug*
 

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Was this in the context of a shoulder dystocia? I know that with SD, changing to the ANY opposite position can shake things up enough to get that baby unstuck. So in some contexts, flipping mama over and pushing her knees to her chin can be helpful, but it usually happens in a very traumatic hospital birth where personelle is also applying fundal pressure and doing other manuveurs.<br><br>
Clear as mud. (I'm SO sick right now, I can hardly think.)
 

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I think it's okay IF that's what feels right to you at the time to allow for baby's passage. I felt like lying on my back resting against the couch armrest to push out #3, so I did, though I had my feet down and my butt in the air for the actual contractions because I was free to move, so maybe that doesn't count.<br><br>
For my biggest baby I actually felt like sitting semi-reclined, go figure.
 

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I think the other post was saying that lithotomy is better than semi-reclined, which puts pressure on your bottom and can reduce the opening of the pelvis. I still think that squatting is better than lithotomy, but lithotomy isn't the worst position... if that makes sense.
 

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I thought lithotomy was like at the gynecologist where your feet are up in stirrups and your butt's sort of elevated and laying on your back was just that, with your legs bent out to the side.
 

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I think I made the original comment, but I was referring to laying on the back, not on the back with legs in the air! And I certainly don't think it's a better position to birth in. Most women can birth just fine semi-sitting if that's what they choose even though it does not create as much room in the pelvis.<br><br>
Lithotomy position, like all interventions, is overused but exists for a very good reason. I believe that natural birth advocates really do a disservice to women by telling them that one thing or another is "always" bad, because on the rare occasion that they are necessary the women feel cheated and sometimes downright abused. I've had to suggest it twice in my career, both times after attempts to get the mother into a squat failed. The first had a baby with a nuchal hand and nothing else we tried could open the pelvis wide enough to birth a head and hand at the same time. The other was an obese lady whose extra tissue was holding back descent. The procedure and result were the same in both cases, yet the first lady thanked us profusely for using our wisdom to get the baby out at home while the second was disgruntled.
 

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FWIW, I thought that I'd want to birth squatting. But, there I was in the tub, sitting on my butt with my legs pulled back and semi-reclined... and my MW said "is this position good?" just when I was considering moving to try something else. Then, all I could respond with was "I feel him!" as I felt his head passing through the cervix... well, at that point, nothing in the world could have gotten me to move, because I just wanted him OUT. LOL<br><br>
So, even the 'bad' positions can be good. I think the main thing is to be able to move if you need to, or if one isn't working or too painful.
 

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<div>Originally Posted by <strong>barefootpoetry</strong> <a href="/community/forum/post/10313374"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">In another thread I read a number of posts describing how lying flat on your back allows your pelvis to open, and that it's similar to a squat just without the aid of gravity.</div>
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the only helpful on-the-back position that I can think of that opens the pelvis is the 'McRoberts Maneuver", as pictured in figure 6:<br><br><a href="http://www.aafp.org/afp/981101ap/morrison.html" target="_blank">http://www.aafp.org/afp/981101ap/morrison.html</a><br><br>
The authors of this article are talking about it in the context of shoulder dystocia, and I saw it in person (as doula) after a mama had an extremely lengthy pushing stage and was too exhausted to stand up. It was not a comfortable position for the mama.
 

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I posted on the other thread as well, and yes, figure 6 in the above link is what I was referring to. As one of the other posters on the other thread indicated, lying on your back with your legs pulled up (as shown in the figure) is similar to a squat, <i>except</i> you don't have gravity working for you. So the opening of the pelvis is similar (IF you are lying flat, and not semi-reclined), but it still isn't necessarily an easy position to give birth in. Like I said on the other thread, this came up btw my mw and I because one of her clients pushed like this for a while -- mama was small, baby was very large, and they wanted the largest possible pelvic opening and were worried a squat would make things go too fast and mama would tear. In the end, lying on her back did not work, so she took the risk of tearing and birthed in a squat (and unfortunately did tear quite badly -- but you do what you gotta do).<br><br>
I also attended a friend's birth recently, and they thought from u/s that the baby was large (9 lb, which is just HUGE, right? <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/rolleyes.gif" style="border:0px solid;" title="rolleyes">), so they were freaked out about shoulder dystocia and told her she "had" to birth on her back, even though she really wanted to be on hands and knees (this was at a hospital). Funny thing is, the Gaskin maneuver for shoulder dystocia has mom on hands and knees, but I guess the CNM wasn't up on that move <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/shrug.gif" style="border:0px solid;" title="shrug">. Everything ended up going fine and there was no shoulder dystocia.<br><br>
Anyway, I don't think anyone is advocating for the lithotomy position, just pointing out that it can be useful in very specific circumstances or when it feels right for mom. I totally believe that it is abused by the medical establishment, and most women do not benefit by giving birth in that position.
 

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I could NOT labour on my back, it was like torture. However I found it very comfortable for pushing, and that is how I gave birth to my DD. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/shrug.gif" style="border:0px solid;" title="shrug">
 

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I believe in Birthing from Within, she says that lithotomy is preferable to the semi-sit. While I can see why she might say that, I disagree. For one, when you're in lithotomy, birth is just happening to you, with people holding your legs and something happening around the area of your vagina that you can't see or connect with. At least in semi-sitting you can be an active participant. I'd avoid either of these if possible but I would personally take semi-sit over lithotomy.
 

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I think it is mind set and not position-- hands and knees certainly doesn't put anything any closer to you but I bet you would argue for that position -- lithiotomy and semi-sit have been way way over used- mom should be able to move in labor and birth- I think that is probably the biggest difference is someone putting you in a position or are you taking up/trying a position is someone assisting you or is someone taking over? I have seen women in what ever position wanting to stay in that position and telling someone get your hands there and catch the baby- or grab the baby... but I would only state that there are occasions I have seen it work- for what ever reason- and I have seen women have a bad reaction to the suggestion-- one gal inparticular 6th baby 5th HBAC PROM for a few days... finally slow labor and the baby is bobbing will not go in and stay she is worn out but won't rest-- and she even gets fully dilated but baby is still minus what I want her to try is to lay down - she will not lay on her back even for 5 minutes- because of everything she has read- and she does not tolerate a belly band - and I think if we only get this kid lined up a few contractions and she'll be right out- mom will do a bit of side lying but the baby is basically laying on the bed beside her--- and she falls asleep- good maybe this will work nope up 15 minutes later and says lets go get a c-section - she would rather get a section again after 4 successful hbacs than lie on her back... because of beliefs and ideas that lying on your back is the worst thing you can do! - that kid had no molding what so ever just never lined up-- and she was having excellent contractions- I have also seen it work which is why i suggested it
 

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I tried everything with ds then final 25 minutes (of 4.5) was in McRoberts He did not want to come out. I was med free too. I was trans. and the Docs were wanting to secytion 2 hours ago. So I guess McRoberts was the least of my problems.
 

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<div>Originally Posted by <strong>SublimeBirthGirl</strong> <a href="/community/forum/post/10320899"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I believe in Birthing from Within, she says that lithotomy is preferable to the semi-sit. While I can see why she might say that, I disagree. For one, when you're in lithotomy, birth is just happening to you...</div>
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No one is arguing that the lithotomy position is a good position to birth in. The point is that it allows for more room in the pelvis.<br><br>
There is no perfect position, each one has advantages and disadvantages, the most important being mother's preferences.
 
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