Pregnancy & Birth

The bizarre reason why women started giving birth lying down

It hasn’t always been the go-to position.

By Mahalia Chang
When you think of women giving birth, there's usually a common image that flashes to mind: a woman, red in the face, lying on a hospital bed with her legs in stirrups. This image, which we get from movies, TV shows, ads, commercials and just about every other type of media out there, has shaped the way we think about childbirth.
But despite that being the most prevalent image of labour — and the most prevalent choice for women, with a 2013 survey revealing that 78% of women in Australia gave birth lying down — giving birth this way hasn't always been the number one position for birthing mothers.
Some of the earliest records of labour show women adopting a sitting, squatting or standing position while in labour. An ancient sculpture from Egypt shows Cleopatra (69 - 30BC) kneeling down to give birth, surrounded by five attendants. Evidence of birthing stools and chairs date back to Babylonian times, and surveys conducted in 1882 and in 1961 have shown that the lying down position has never been the norm in traditional cultures.
So why is it so popular now?
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Well, it turns out that the rise in popularity of the position didn't have much to do with women's experiences at all. According to several medical articles, royalty could have been to blame.
King Louis XIV, who ruled France from 1643 to 1715, played a huge hand in popularising the lying down position... for a very odd reason. According to legend (and a handful of medical scholars), Louis XIV — who had over 22 children by both wives and mistresses alike — had a fascination with watching women give birth.
Lauren Dundes, a professor of sociology, wrote that Louis XIV "enjoyed" watching his mistresses give birth, and disliked the upright or squatting positions for "obstructing" his view of the process.
"Since Louis XIV reportedly enjoyed watching women giving birth, he became frustrated by the obscured view of birth when it occurred on birthing stool, and promoted the new reclining position," wrote Dundes in the American Journal of Public Health. "The influence of the King's policy is unknown, although the behavior of royalty must have affected the populace to some degree."
It is reported that, knowing the king was a fan of the lying position, the lower classes began to adopt the practice to follow suit.
François Mauriceau, a French obstetrician, has also been credited with popularising the lying position. Writing in 1668, Mauriceau advocated for horizontal births, "to shun the inconvenience and trouble of being carried thither afterwards."
"The bed must be so made, that the woman being ready to be delivered, should lie on her back upon it, having her body in convenient figure."
Mauriceau was also the man who has been attributed with viewing pregnancy as an illness (or, as he referred to it, "a tumour of the belly"), rather than a natural condition. This classification of babies as being 'medical problems' helped to open the door for "barber-surgeons" to enter into the field, ushering midwives out.
But just because the notion of giving birth lying down came into popularity in a slightly strange way, doesn't mean that there's anything wrong with the practice itself.
Dr Charlotte Elder, obstetrician and spokesperson for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, tells Now To Love that the position is often used because it's the most comfortable.
"Most women give birth in what you call a 'semi-recumbent' position, which is not actually lying down like most people would expect. Most people give birth being propped up, similar to the position you would be in sitting in a beanbag, not lying flat."
"The main reason people give birth in that position is because it's comfortable, and they can get their legs in a good position to help open their pelvis to give the baby lots of space," says Dr Elder. "And with the way our lifestyles are now, people are very used to things that are in a sitting position – lots of people work office jobs, or spend time commuting in cars. Compared to how things used to be, even 100 years ago, women spend less time squatting and less time standing. If you try and see how long you can squat for, with your heels on the ground, it's actually quite difficult."
As for the King Louis XIV-supported position — that is completely flat with the shoulders on the bed — Dr Elder agrees that that position is not a great option... for the 1600s royal mistress, or for a 2018 mother.
"There was a time when women were encouraged to give birth lying much more flat, which was, in part, to make it easier for the doctors and midwives [to see]. I don't think that's a good thing at all."
"I was quite horrified when I watched the final episode of the first season of Offspring. [Show character Kim] was in a pub giving birth and she was leaning up against the edge of the pool table. From my point of view, as an obstetrician, that was a fantastic position to give birth in! Her pelvis was nice and open, she was supported on the pool table which was a good height, her back was in a good position… I was watching, saying, 'Fantastic!'"
"And then the characters said, 'Oh, the baby's coming!' and threw her on the pool table, lying on her back! I can't imagine anything more uncomfortable, if you compare the two positions."
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"I get riled up as everyone else, seeing things in the media that aren't right. I can understand how women, from popular culture and from media, would feel like giving birth lying down is just 'what happens.' It doesn't surprise me, that that's how women feel. But it's a bit sad, because you should follow your body and do what feels right, and not be limited by expectations."
But birth plans and labour charts aside, getting into position once you're in labour is usually more about what's comfortable, rather than what's in vogue.
"That's the thing with birth, you can plan, and think, and dream, and imagine what it's going to be like, but until it actually happens… it's a pretty universal experience where everyone says, 'I didn't think it would be like that!'"
"I would empower women to be confident that they can move into different positions, and not to feel like there is a 'right' way to do things. The right way is what feels comfortable at the time."
"The only rule in labour is that you have to take your knickers off!"