"I may or may not burst some bubbles with this comment, but what if I told you that your pelvis was in fact not too small and or that your baby's head was in fact not too big?" says Amber Grimmett, a US-based Pregnancy and Postpartum Coach. In her post, she also writes that the position most women give birth in, also called the lithotomy position or lying on your back is "against your body's natural birth mechanics". In a video she posted on her Instagram @fierce.not.fragile, she talks about pelvis and baby's head size, explaining how the birthing position that has been made standard may not be right. She says that when the mother lies flat on her back with knees wide, her tailbone cannot move freely and the pelvic outlet, the space baby needs to exit, "literally closes off". This, she says, creates a domino effect. Then comes longer labors, more interventions, and higher risk of pelvic floor dysfunction. "Your body was designed to birth, but not in positions that fight against its natural design," she writes. What Does Science say?We did a fact check on her claim and here's what we found.For most women in the United States today, giving birth means lying on a bed, feet in stirrups, and being told when and how to push. But mounting research, including a 2014 study published in The Journal of Perinatal Education, titled, 'Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body’s Urge to Push' suggests this common practice, known as the supine or lithotomy position—might not actually be the safest or most effective way to bring a baby into the world.How Birth Ended Up on Its BackFor centuries, women birthed in positions that worked with gravity, standing, squatting, sitting, or even using stools or ropes for leverage. These upright positions made physiological sense: gravity helped the baby descend, shortened labor, and reduced maternal fatigue.Then came King Louis XIV of France. Fascinated by childbirth, he reportedly preferred to watch his mistresses deliver, and lying flat gave him the best view. The practice caught on among European aristocracy and eventually spread widely.By the early 1900s, births had largely moved from homes to hospitals. Doctors saw childbirth less as a natural process and more as a medical procedure. Putting women on their backs gave physicians easier access for interventions such as forceps delivery, anesthesia, and continuous fetal monitoring. Convenience for the doctor—not necessarily benefit for the mother or baby, became the standard.The Problem with the Supine PositionResearch over the past three decades has consistently shown that giving birth lying flat has no clear benefits for either mother or baby. In fact, there are multiple disadvantages:Longer Labor: When women lie flat, the baby must work against gravity, which can slow descent.Narrower Pelvis: The supine position can actually reduce pelvic diameter, making delivery more difficult.Increased Risk of Interventions: Supine births are linked with more use of forceps, vacuum deliveries, and episiotomies.Reduced Blood Flow: Lying on the back can compress major blood vessels behind the uterus, reducing blood flow to the baby.More Perineal Trauma: Directed, forceful pushing while on the back is associated with more tears and a weakened pelvic floor, raising the risk of urinary incontinence later.Despite this, U.S. survey data shows that nearly 70% of births still happen in supine or lithotomy positions, with fewer than 10% of women using traditional squatting, standing, or side-lying positions.The Case for Upright and Spontaneous PushingStanding, kneeling, and squatting use gravity to help the baby descend and can even widen the pelvic outlet, giving more room for delivery. Even side-lying, which is gravity-neutral, has been shown to reduce perineal tearing.Equally important is how women push. Many hospitals still direct women to push forcefully for long periods, holding their breath. But evidence shows that spontaneous, self-directed pushing—where the woman follows her own urge, improves oxygenation, reduces maternal stress, and lowers the risk of fetal distress.In fact, research has found that directed pushing only shortens labor by about 13 minutes on average, a difference not considered clinically significant but one that may come at the cost of pelvic floor damage.Rethinking Hospital PoliciesSome hospitals have strict time limits on how long the second stage of labor (pushing phase) can last before recommending interventions such as a C-section, even if there are no signs of danger for mother or baby. Recent guidelines from the American College of Obstetricians and Gynecologists (ACOG) now acknowledge that the second stage can safely last much longer, up to five hours for first-time mothers with an epidural.However, there is little emphasis on letting women move freely, change positions, or delay pushing until their natural urge returns. This gap between research and practice persists, though midwives and doulas are often more supportive of these evidence-based approaches.
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