For thousands of years, women across the globe birthed in upright positions. Whether kneeling like Cleopatra, using stools, or squatting, the method was simple: work with gravity. Modern science confirms that squatting can enlarge the pelvic diameter by at least 2.5cm. Yet, most women today find themselves confined to their backs.
“There is a generalised ignorance amongst professions and pregnant women about the physiology of birth,” says Janet Balaskas, founder of the Active Birth Centre and author of the Active Birth Manifesto.
In her 1982 manifesto, Balaskas notes: “Throughout the world, and for thousands of years, women have spontaneously laboured and given birth in some form of upright or crouching positions. Whatever the race or culture… the same upright positions predominate.”
The Invention of the “Passive Patient”
The shift to lying down is a relatively modern phenomenon. Most women in post-industrial countries are now treated as “passive patients” in hospital settings. Balaskas argues this practice is “illogical,” making birth “needlessly complicated and expensive.”
Hannah Dahlen, professor of midwifery at Western Sydney University, agrees that giving birth lying down is a recent trend. It only began in the past 300 to 400 years, largely due to François Mauriceau. This French doctor claimed the reclining position was more “convenient” for the male physician.
A Royal Preference?
Some scholars believe the change was driven by King Louis XIV. “Since Louis XIV reportedly enjoyed watching women giving birth, he became frustrated by the obscured view of birth when it occurred on a birthing stool, and promoted the new reclining position,” wrote Lauren Dundes, a professor at McDaniel College.
Regardless of its origin, the trend stuck. Birth became institutionalised, and “natural” physiological birth options declined.
The Science of Active Birth
The benefits of upright birthing positions are backed by data. A 2013 review of 5,200 women found that those who stayed mobile had a lower risk of Caesarean birth and used fewer epidurals. Their babies were also less likely to enter neonatal units.
Professor Dahlen lists further advantages of staying upright:
- More efficient contractions.
- Reduced maternal pain.
- Fewer vacuum births or episiotomies.
- Better oxygen for the baby.
Choosing the Right Path
In the UK, NICE guidelines now suggest women should be “discouraged from lying supine” during the second stage of labour. Instead, they should adopt any position they find comfortable.
“Public education about birth options will always be useful,” says Eileen Hutton of McMaster University. She notes that popular media often misrepresents the process. By understanding the history and science of maternal health, women can regain control over their own experiences.
