When an average person thinks of labor and birth, an image of a woman lying flat in a bed, possibly with her feet in stirrups or her legs being held back against her chest, pops into our heads. Although this position is common practice in many hospitals and medical institutions for use during labor and delivery, it is not evidence-based. This position is known as the lithotomic position. The use of this position has decreased in every industrialized country aside from the United States.
What is the lithotomy position?
The lithotomy position is the position in which a woman is lying on her back, her legs apart and feet supported. The word “lithotomy” is derived from the Greek words “litho” (stone) and “tomos” (cut). The name was coined for the position that ancient Greeks used when cutting kidney stones from patients. Although this position is idea for examinations involving the vagina, it is not necessarily ideal for labor.
Why is this a bad position to labor in?
The lithotomy position is one of the worst positions for a laboring woman to assume if she does not need to (such as in the case of an epidural or other medical reasons that necessitate this position). The lithotomy postion causes the weight of the uterus and baby to put pressure on mother’s main blood vessels, such as the vena cava. This compression may cause poor oxygenation to the body of the mother and the baby, which may lead to fetal distress.
The lithotomy position has been known to cause issues with the sciatica nerve, and has been responsible for deep vein thrombosis.
The lithotomy position reduces the pelvic outlet by up to 30%, making the pelvic outlet more difficult for the baby to navigate when making it’s natural cardinal movements. Because of this, the baby is much more likely to become malpositioned for labor which may increase the need for interventions.
The lithotomy position places unneeded pressure on the mother’s spine, as well as unnecessary pressure on the mother’s perineum (the area between the mother’s vaginal opening and the anus) which may place her at a greater risk of tearing in labor, or requiring an episiotomy.
The lithotomy position is very uncomfortable for women, and may even prolong labor and intensify the pain resulting from it. This is due to the natural birth path. When lying in the lithotomy position, the woman is essential forced to work against gravity to deliver her baby, thus intensifying and lengthening her labor and pushing more than necessary.
Why is the lithotomy position still used?
The lithotomy position has a great many disadvantages for women who labor and birth in is, so why is it still used? The lithotomy position is so commonly used because it provides the physician or care provider easier and more comfortable access to the laboring woman and the baby for examinations and interventions, such as forceps. The lithotomy position is more physician-friendly than patient-friendly.
How can the lithotomy position be avoided?
A woman should ensure she has discussed freedom of position during labor with her caregiver. Choosing a caregiver who is flexible and accommodating when it comes to labor positions is more likely not to pressure the woman into the lithotomy position.
Developing a birth plan explicitly describing your desires for positioning in labor and pushing may be helpful in making the hospital staff aware of your intentions. If you have not written a birth plan, it is important to do so before labor. If you have hired a doula, she may help you develop a birth plan. There are also numerous birth plan templates available online for you to customize and tailor to your own birth desires.
The lithotomy position is usually not pressured or encouraged for women out of mal-intent, but rather ignorance and misinformation. If a woman feels she is being pressured to get into a position that isn’t comfortable or beneficial to her labor, she should be encouraged to speak up, stating her desires and following through with them. If the woman had hired a doula, this task may be easier to handle.
“The Evil Lithotomy Position.” Empowering Each Woman Giving Birth Naturally. Web. 21 Sept. 2010.
“Lithotomy Position for Labor.” Birthing Naturally. Web. 21 Sept. 2010.
“What Is The Lithotomy Position?” Web. 21 Sept. 2010.