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Birth Positions

How the Right Position Can Prevent an Episiotomy

By Laura Cone

Hollywood often portrays women giving birth in the hospital with their legs in stirrups, but to avoid tears and the need for an episiotomy, experts say a woman should follow her natural instinct to squat.

Rachel Silber, a certified doula with the Doulas of North America who lives in Potomac, Md., says any position is preferred to lying flat on your back.

Silber, who has two children, says there are two "best" positions to avoid the need for an episiotomy – a surgical enlargement of the vagina by means of an incision in the area between the vagina and rectum. These positions are the squatting and hands-and-knees positions.

"Squatting, in particular, lines the birth canal with the bones of the woman so the baby is descending in a more linear fashion," Silber says. "If you are lying on your back or semi-seated position, the baby has to come down and takes a turn just behind the pubic bone and then has to kind of come uphill. When you are in the standing or squatting position, everything is lined up so there is not that big U-turn."

She says gravity helps bring the baby down. Also, a woman is more likely to relax and open up when she squats.

If you plan to have an epidural, you don't need to be on your back. Many birthing beds can move into a more upright position. Also, she suggests checking with your doctor or midwife about using a squatting bar.

"It's an optional piece of equipment," she says. "Most hospitals have them, although you might have to find them in the closet to locate them. The squatting bar attaches to the bed, and the bed will hold the mom upright and the bar will help support her so she doesn't fall backwards. I've had moms use the squatting bar to help them with pushing. It does help."

Other possible positions for giving birth include kneeling or lying on your side.

Want to see more?

• Episiotomy: Is it Necessary?
• Avoiding Routine Interventions in a Hospital Birth
• Easing Labor Pain
• Talk about it!