Given freedom of choice, few women in any part of the world lie down during labor. The supine (flat on the back) position reportedly originated in the French court of Louis XIV. A voyeur who relished watching his mistress giving birth, the king's quirky preferences soon dictated fashion for the country. The supine position found almost universal favor in United States hospitals from the 1940s on because a woman's lying flat enabled her obstetrician to perform interventions such as forceps delivery, anesthesia, and episiotomy more easily.

But lying down has no medical benefits for most mothers. In fact, it carries several proven risks. When you lie on your back for long periods of time, the weight of the uterus compresses the descending aorta and inferior vena cava, blood vessels that supply or drain the lower part of your body. This interference with your circulation reduces your blood pressure, compromising blood flow to your baby and causing his heart rate to drop. When you stay upright (or at least off your back), placental circulation improves and fetal heart rate abnormalities may be alleviated.

A host of medical studies have demonstrated conclusively that upright positions shorten and ease labor. One famous Latin American study comparing reclining to vertical positions showed that labors for women who stayed upright were 36 percent shorter for first-time mothers and 25 percent shorter for mothers who had previously given birth. A British study comparing mothers who walked during labor to mothers who stayed in bed demonstrated that walking not only shortened labor but also reduced pain and the need for medication.

How does walking help your labor along? For one thing, your contractions become stronger, more regular, and more frequent when you stand up. Gravity helps your baby make his way through your pelvis. Furthermore, the upright position improves both the angle of your baby's body to your spine and the application of his head to your cervix. Because your uterus naturally tilts forward in your abdomen during contractions, it meets the least resistance when you are standing, leaning slightly forward. Finally, even though contractions get stronger when you're upright, many women feel more comfortable, more in charge, and better able to relax in this position. A typical mother put it this way: "When I lay down, it slowed my labor down in the early stage. When I was in active labor, I found lying down much more painful than when I was walking."

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