Is pushing on your back always a bad thing?
Pushing on your back has a bad rap for quite a few reasons. One, it’s the prime pushing position in the hospital setting, known for convenience for the doc as well as one of the only options you have if you get an epidural. It’s also known that if you’re pushing at a reclined 45 degree angle on your back, you are literally closing off your pelvis by putting pressure on the tailbone and sacrum.
But is there ever a time and a place for pushing on your back, and if so, what is the best way to get that tailbone out of the way?
When pushing phases are long and difficult, one of the positions we find the most success with, especially for first or malpositioned babies, is a position called McRoberts, which is….. gasp… flat on your back. Sometimes our clients get a little confused when we suggest they try getting onto their back, because they have heard you don’t want to push on your back and that is part of why they chose midwifery care! But the difference here to take note of is that in McRoberts, you are flat on your back with your knees pulled up, which swings your pelvis up off the bed, opening the back of the pelvic outlet completely. Imagine that you’re in a deep squat, but are laying on your back. The benefit of a squat is often that gravity is working with you, so what is the benefit of that deep squat on your back?
Often what we see is that the baby is having a hard time getting under the pubic bone and staying. Using the McRoberts position is often where we see a ton of quick progress where gravity helps the baby get under the pubic bone and stay there. So while this might not be the position you would have imagined birthing your baby in at home, and it’s absolutely not our first go to, sometimes it is a position we see make all the difference when your body or baby are requiring you to work really hard to get your baby out.
If you’re in the hospital setting giving birth and want to better facilitate the birth of your baby while you have an epidural in place, asking to be fully flat on your back can help provide more space for your baby at the back of the pelvis.
So if your home birth midwife ever says, can we try getting on your back to see if that helps you move your baby? We aren’t going hospital mode on you, and it’s definitely not for our convenience. It’s because this is a position that often works well in making some good progress to bring your baby into your arms when other positions aren’t working well.