For thousands of years, women across cultures gave birth in upright positions such as squatting, kneeling, or using birthing stools. Yet today, most births happen with women lying on their backs—a shift experts say is rooted more in history than biology.

A natural process changed over time

According to experts like Janet Balaskas, upright birthing positions were once the norm worldwide, as they work with gravity and help widen the pelvis, making delivery easier.

However, this changed over the past few centuries, particularly with the rise of medicalised childbirth practices.

The influence of early medicine

French physician François Mauriceau played a key role in popularising the reclining position in the 17th century. He viewed pregnancy as a medical condition and argued that lying down was more convenient for doctors.

Some historians also link the shift to Louis XIV, who reportedly preferred observing births in a reclining position—possibly influencing broader societal norms.

Why upright positions are beneficial

Scientific studies support the benefits of upright labour:

  • Helps gravity assist the baby’s movement
  • Reduces labour duration
  • Lowers chances of caesarean sections
  • Minimises need for pain relief interventions
  • Improves oxygen flow to the baby

Research shows women who remain mobile and upright during labour often experience smoother deliveries compared to those confined to beds.

Hospital practices and modern constraints

Despite these benefits, hospital environments often limit movement, with monitoring equipment and standard beds encouraging a lying-down position.

Experts say this approach can make childbirth more complex and turn a natural process into a highly medicalised one.

Growing awareness of ‘active birth’

There is increasing global awareness of “active birth”—an approach encouraging women to move freely and choose positions that feel natural during labour.

Guidelines in countries like the UK now advise against lying flat during the final stage of labour, recommending positions that promote comfort and efficiency.

Empowering women with choices

Experts emphasise that awareness is key. When women understand their options, they can make informed choices about their birthing experience.

As research and awareness grow, there is a gradual shift towards more flexible and mother-centred childbirth practices.