For most of recorded history, people giving birth were free to move about during labor. They often adopted upright positions that felt more comfortable and eased the pain of contractions.

In 1700s lying down to give birth became more common, as it allowed obstetricians easier access for examinations and interventions. As birth moved from home into hospital during the 1900s, this medical model of birth position became a cultural norm.

We often now expect that people will labor in bed and deliver on their back, often holding their legs up or placed in stirrups. However, this is a physiologically dysfunctional birthing position, narrowing the pelvis and restricting the ability of the sacrum and coccyx to swing out and make space for baby.

Evidence shows the benefits using upright positions for better birth outcomes.

8 benefits of upright birth:

1. Uses gravity to help baby come down through the pelvic
   
   Why work harder than you need to? Your uterus contracts out — or forward — from your body. When you’re upright, you can work with gravity and your body’s natural functions in labor. When you’re lying down, you’re bearing the brunt of weight and force, which is going against gravity.
   
   
2. Fewer interventions necessary when there is enough space for baby
   
   When you’re giving birth upright, making use of gravity and more effectively using your muscles, you’re less likely to need interventions such as forceps, vacuum, or episiotomies. When you’re working against gravity in dysfunctional position, both you and your baby are more likely to need help.
   
   
3. Forward leaning positions can lead to more efficient contractions
   
   When you’re upright, leaning forward and working with gravity, your contractions will become much more efficient. If you’re lying on your back, your uterus will be contracting upwards, which is not working with your body, but against it.
   
   
4. Less pain
   
   For most people, laying on their back is the most uncomfortable and painful position in which to labor. When you’re off your back, you’ll experience less pain than you will giving birth lying down. This is because you have all the weight on your back and you’re working against gravity.
   
   
5. Shorter labors
   
   Being upright and active has been shown to shorten active labor and pushing times. When you’re working with gravity, in a position that your body and baby is designed to work well, your labor will likely be much shorter. Although, it probably would be closer to “normal” — because lying down may slow your labor down.
   
   
6. Better oxygen transfer to your baby
   
   When you’re lying on your back, you’re bearing the full weight of the baby, your uterus, placenta, and all that comes with it. Doing so puts pressure on important blood supplies in your own body. Compressing the blood supply also compresses the oxygen supply to your baby. By being upright, you’ll provide a better oxygen and blood supply to your baby. In turn, this means that your baby will be less likely to experience fetal distress. Fetal distress that cannot be rectified quickly usually results in a cesarean section.
   
   
7. A more positive and satisfying birth experience
   
   Studies have shown that by giving birth upright, a person’s overall satisfaction of their birth increases. And that’s no surprise given what we’ve already learned – that an upright labor can result in a less painful labor, with less intervention likely, and so much more.
   
   
8. Significantly increases space for baby in the pelvis
   
   Lying down reduces pelvic diameter about 30%. Especially if you have concerns about having a big baby (which you shouldn’t be, because your body is cleverly designed to birth!), lying down is not going to help your body open as well as it could. Being upright opens up your pelvis, whereas lying down closes it up. This is why scans are inaccurate in diagnosing your pelvis’s ability to birth your baby.