The Dark History Behind the Most Common Birth Position

If you close your eyes and picture a woman giving birth, chances are she’s lying flat on a bed, legs hoisted, bright lights above, a clinician stationed “down there.” It feels clinical. It feels modern. It feels inevitable.

But inevitability is not the same as wisdom. For most of human history, women gave birth in various positions; squatting, kneeling, standing, or on birth stools; positions that harness gravity, open the pelvis, and allow the birthing person to move with the contractions.

The supine/lithotomy position (flat on the back, legs up) is a comparatively recent trend, and it didn’t spread because it was safer or kinder to women. It spread because it was convenient—first for observers and then for doctors.

Photo Credit: Nurseslabs | The lithotomy position is associated with increased maternal pain, lower blood pressure, a higher risk of perineal injury, and more frequent need for forceps or Caesarean sections compared to alternative positions.

This is the story of how a posture became a paradigm, why it stuck, and how women and midwives around the world are quietly, sometimes loudly, taking it back.

The Creepy Legend, the Messy Truth

You’ve probably heard the viral claim: King Louis XIV of France liked to watch his mistresses give birth, so he favored a position that gave him the best view; physicians obliged, and the flat-on-the-back norm was born.

It’s a sensational story—and that’s exactly why it travels so well online. But historians and fact-checkers say the tale is mostly false: there’s no solid evidence Louis XIV single-handedly changed global obstetrics, even if he was reportedly fascinated by childbirth.

While legend often blames Louis XIV’s voyeuristic preference for watching his mistresses give birth, historians point instead to physicians like François Mauriceau, a 17th-century French obstetrician. In his 1668 treatise Traité des Maladies des Femmes Grosses, Mauriceau advocated the supine position, arguing it gave doctors better control and visibility.

Around the same time, the Chamberlen family, who invented the obstetric forceps, found their tool worked best when women lay flat on their backs with legs restrained. Together, these medical practices shifted childbirth away from upright, midwife-led traditions toward the lithotomy position—establishing a doctor-convenient norm that would dominate delivery rooms for centuries.

Photo Credit: Google | The obstetric forceps were invented by the Chamberlen family, specifically credited to Peter Chamberlen the Elder, in the late 16th century. The Chamberlen family, originally French Huguenots, migrated to England in 1569. They kept the design of the forceps a family secret for over a century, using it to assist with difficult childbirths.

So what did happen?

In the 17th century, two big shifts converged:

• Male “man-midwives” and obstetricians moved into a space historically led by women midwives, bringing new tools and a drive for visibility and control.

• The obstetric forceps, closely guarded by the Chamberlen family for decades, emerged and diffused. The lithotomy position made it easier for physicians to use instruments and observe the perineum.

In other words, the modern default wasn’t created by a king’s voyeurism so much as by medicalization and instrumentation. The patient’s position shifted to suit the operator’s hands and eyes.

What the Evidence Says About Positions

Contemporary research has revisited an old intuition: upright and lateral positions often improve labor dynamics and maternal experience. Reviews and trials suggest:

• Upright or lateral positions are associated with shorter second stages, less need for augmentation, and higher reported satisfaction—though results can vary by epidural use and study design.

• Systematic reviews note that supine/lithotomy positions correlate with longer labors, more pain, and less favorable fetal heart rate patterns. Some upright postures may carry a slightly higher measured blood loss threshold ( more than 500 ml), which clinicians can anticipate and manage.

• Large population studies link lithotomy with higher rates of obstetric anal sphincter injury (OASIS), while standing and lateral positions tend to show the lowest rates.

None of this means there is one “right” position for everyone. It means choice and mobility matter—and the old default isn’t neutral.

What WHO Recommends (Spoiler: Choice, Movement, Respect)

The World Health Organization’s guidelineIntrapartum Care for a Positive Childbirth Experience emphasizes exactly that: woman-centered care that preserves mobility and supports a position of choice during labor and birth. The guideline packages dozens of recommendations that, together, seek to reduce unnecessary interventions and improve experience and outcomes.

WHO’s approach is less “everyone should squat” and more “every woman should be able to move and choose.” In plain terms: the person doing the work should be the person deciding the posture—unless a clinical complication clearly dictates otherwise.

This matters in a world where interventions keep rising. Globally, caesarean sections account for about one in five births (21%), with projections approaching 29% by 2030—a mix of lifesaving operations and preventable overuse, depending on the setting. Reducing blanket protocols (like mandatory supine positioning) is part of the broader push to reserve interventions for when they’re truly needed.

Photo Credit: Pinterest

The Feminist Perspective: Whose Body? Whose Convenience?

From a feminist lens, the lithotomy default is a case study in how patriarchal structures colonize the body. The shift from midwife-led, movement-friendly births to doctor-centered, bed-bound births mapped power onto posture. The lit room, the raised legs, the fixed gaze—these are architectural choices that privilege the operator, not the laboring woman.

A few uncomfortable truths:

• The bed is a technology of control. It corrals a moving body into a manageable field for measurement, monitoring, and intervention.

• “Standard position” is not neutral; it’s a historical artifact that aligned with male professional authority, not evidence of superior outcomes.

• When women are told to stay in one position “for the monitor,” the implicit message is that the machine’s needs outrank the mother’s—even though telemetry and intermittent monitoring can often accommodate movement. (WHO explicitly supports approaches that preserve mobility and autonomy.)

Feminism isn’t anti-medicine; it’s pro-consent and pro-informed choice. It asks, Who benefits from this posture? If the answer is “the clinician” more than “the patient,” then the default needs scrutiny.

Global Snapshots: Old Habits, New Momentum

How entrenched is the supine/lithotomy default today? It varies by region and by hospital.

• Italy: In one region, over 56% of births were in lithotomy, with some facilities reporting approximately 80%. That’s not physiology—that’s culture and workflow.

• Multi-country/clinical settings: Surveys commonly report that, even when nurses and midwives know upright options and believe women should choose,lithotomy remains the most used, explicitly for clinician convenience.

• Population outcomes: Large datasets consistently associate lithotomy with higher severe perineal injury rates versus standing or lateral births, strengthening the case for routine alternatives.

The momentum is shifting, though. Trials comparing squatting or sitting to lithotomy show shorter second stages, fewer extensions of episiotomies, and higher maternal satisfaction—without compromising neonatal outcomes when practiced in appropriate candidates with skilled support.

Myth-Busting Without Losing the Plot

Let’s not replace one myth with another. A few clarifications:

• Louis XIV didn’t “invent” supine birth. The story survives because it’s lurid and memorable, but the evidence points to a broader professional and technological shift in the 1600s–1700s, not a monarch’s kink.

• Forceps weren’t villains. In obstructed labor, they were (and are) lifesaving when used judiciously. The harm came from making the tool’s ease the organizing principle of normal labor.

• Upright isn’t a magic wand. Some upright postures can correlate with greater measured blood loss, and certain complications genuinely call for supine positioning. The point is informed choice, not replacing one rigid rule with another.

The Physiology You Can Feel

Why do so many women instinctively get off their backs if allowed?

• Gravity helps the baby descend and aligns the fetal head with the pelvis, often shortening the second stage by minutes to half an hour, depending on the study.

• Perfusion is better: lying supine can compress major blood vessels, reducing uterine blood flow; upright reduces that risk and can improve fetal oxygenation.

• Pelvic diameters open differently in squatting, kneeling, or on all fours, changing the mechanics of descent and rotation.

These are not ideological claims; they are mechanical facts. The body knows.

What a Rights-Respecting Labor Room Looks Like

A “positive childbirth experience,” to borrow WHO’s phrase, is not only about safety metrics—it’s about dignity, autonomy, and support. In practice, that means:

1. Freedom to move during labor, including access to tools like stools, bars, balls, and water—unless a clinical indication genuinely requires restriction.

2. Position of choice for pushing and birth—squatting, kneeling, side-lying, hands-and-knees, semi-sitting, even supine if the woman wants it.

3. Monitoring that follows the mother, not the other way around—intermittent auscultation or mobile telemetry where safe and feasible.

4. Skilled attendants (midwives and doctors) who are competent in assisting birth in multiple positions, not only on the bed.

5. Transparent communication: if a clinician requests supine positioning—for instrumental delivery, shoulder dystocia management, or operative prep—it should be explained as a clinical need, not an unexamined habit.

Why This Still Matters (Even in 2025)

Because habits masquerade as evidence. Even in high-resource hospitals, lithotomy can be treated as “not an intervention,” simply “how it’s done.” But research and global guidance say otherwise: posture is a clinical choice with consequences for pain, duration, perineal outcomes, and experience.

Meanwhile, the world grapples with rising intervention use—some of it lifesaving, some of it avoidable. Rethinking defaults like birth position is low-cost, high-impact, and aligned with both safety and humanity.

For Mothers, Partners, and Clinicians: Practical Takeaways

• Ask early (in antenatal care) how your facility handles positions for labor and birth. If you want to avoid supine, say so in your birth plan.

• Practice positions: side-lying, hands-and-knees, supported squat. Partners can learn to stabilize hips, hold a rebozo/scarf for counter-traction, or anchor a squat with a chair.

• Advocate for mobility-friendly monitoring. If continuous electronic monitoring is suggested, ask whether intermittent or mobile options are appropriate for your risk profile.

• Clinicians: get comfortable catching babies from the side of the bed, at the end of a mat, or in water. Learn to protect the perineum in lateral, kneeling, or semi-sitting postures. The more positions you master, the fewer episiotomies and instrumental assists you’ll need.

The Bigger Picture: Beyond Birth, Toward Bodily Authority

The lithotomy story is a parable about more than obstetrics. It’s about how “normal” can be engineered by power—and then forgotten as a choice. When the body is rerouted to suit the gaze, the glove, or the gadget, that rerouting can last centuries.

A feminist reading doesn’t ask us to reject medicine. It asks us to interrogate its defaults: Who benefits? What does the evidence say? What does the person in the bed (or on the stool, or in the tub) want?

If the answer to those questions sometimes returns us to the oldest knowledge—move, breathe, choose—that’s not regression. That’s progress with a memory.