Why Birthing on Your Back Isn’t Best for Your Pelvis
When most people picture birth, they envision someone lying flat on their back, legs in stirrups, bright lights overhead, and a team of providers between their knees. Thanks, Hollywood. But the reality is this: birthing on your back is one of the least biomechanically efficient positions for labor, especially when we consider the natural movement of the pelvis, gravity, and fetal rotation.
Let’s break down why that is, what positions actually support better birth biomechanics, and how this ties directly into what we do every day in pelvic floor physical therapy—especially right here at Encore Physical Therapy in Overland Park and Kansas City.
Birthing on Your Back: A Modern Invention, Not a Necessity
Historically, birthing upright or in hands-and-knees, kneeling, or squatting positions was the norm across cultures. It wasn’t until the 17th century, when King Louis XIV wanted a better view of childbirth (yes, really), that the trend of women birthing supine began to catch on in Western medicine.
Modern obstetrics adopted this position largely for provider convenience—not because it was best for the birthing person.
When we work with clients at our pelvic floor physical therapy in Kansas City, we are constantly working to create more space in the pelvis—through mobility, strength, breath, and alignment. Birthing on your back works against all of those principles.
The Biomechanics: Why Supine is Suboptimal
Let’s get anatomical for a second. The pelvis isn’t a fixed bowl—it’s a dynamic, moving structure. During labor, the baby must navigate through three main parts:
Pelvic inlet (top)
Midpelvis
Pelvic outlet (bottom)
Each of these spaces opens or narrows depending on position, movement, and muscle tone. When lying on your back:
The sacrum is pinned against the bed or table. This limits its ability to nutate, or tip backward, which is critical for opening the outlet.
The tailbone can’t move, reducing pelvic outlet space.
The weight of the baby pushes directly down on the spine, which increases discomfort and decreases mobility.
Gravity isn’t helping—in fact, it’s making the pushing stage longer and harder.
Compare that to upright, forward-leaning, or side-lying positions, where the sacrum is free to move, the pelvis can expand naturally, and gravity helps descend the baby.
A Cochrane review by Gupta et al. (2017) found that upright positions during the second stage of labor can increase the available space within the pelvis by up to 30%, facilitating fetal descent and reducing the duration of labor. Read more here
This is why pelvic floor therapy in Overland Park focuses not just on pelvic strength, but also on dynamic mobility. When we teach birth prep, we’re not teaching Kegels—we’re teaching functional movement strategies that let your body do what it was built to do.
Supine Position Increases Interventions
Let’s be honest: the way you birth can significantly impact your experience—physically and emotionally. And we know from data that the supine position is linked to a higher risk of interventions:
Increased use of epidurals
Longer second stage of labor
Higher chance of instrument-assisted delivery (forceps or vacuum)
Increased risk of perineal tearing and episiotomy
A study published found that women who gave birth in upright positions had significantly shorter pushing phases and fewer interventions. Check it out here.
This isn’t to shame anyone who birthed on their back. It’s not about guilt—it’s about information. Because informed choices are empowered choices.
At Encore Therapy, we support moms wherever they’re at in their journey. If you had a traumatic birth, a long pushing phase, or just felt like your body was working against you—there’s a reason. And it wasn’t because you “weren’t strong enough.” It was the position, the support (or lack of it), and the system.
You Can Still Move With an Epidural
One of the biggest myths out there is: “Well, if I get an epidural, I have to be on my back.”
Not true.
At enCORE Physical Therapy, we teach movement strategies that are epidural-safe and staff-friendly. As long as you can get into a position with assistance and maintain it with support (pillows, peanut balls, partners), you can still:
Labor in all-fours
Use side-lying with open hips
Try modified kneeling or semi-squats with support
Utilize rebozos or sheets to shift your hips and pelvis
Movement feeds movement. And movement feeds progress.
If you’re local and planning for birth, pelvic floor physical therapy in Kansas City can prep you with positions, breathwork, and pelvic awareness that will help your baby navigate the birth canal with more ease.
Why Providers Still Default to Supine
So if we know all this, why is supine still so common?
Simple answer: convenience. It’s easier to monitor fetal heart tones, place monitors, and manage the birth from a provider standpoint when someone is on their back.
But birth isn’t a procedure—it’s a physiological event.
As patients, we often forget we can say: “No, I’d like to try a different position.” Hospital policies are not laws. Providers may suggest supine for routine, but it is not a requirement.
Want more support advocating for your birth plan? Check out this resource from Evidence Based Birth: Positions for Pushing.
A Better Birth Starts With Better Prep
If you’re local to Kansas City or Overland Park and you’re preparing for birth, it’s not too early (or too late!) to get into pelvic floor physical therapy.
At enCORE Therapy, we work with clients in all stages of pregnancy, postpartum, and even those who are years past birth but never felt like they got their core or pelvic floor “back.” But here's the truth: it’s not about getting back—it’s about moving forward with education and empowerment.
In our birth prep sessions, we help you:
Learn how to lengthen your pelvic floor instead of over-strengthening it
Understand positions that open the pelvis during each stage of labor
Use breathwork and body mechanics that actually make pushing more efficient
Advocate for yourself in the birth space (hospital, birth center, or home)
Birth doesn’t have to happen on your back. It doesn’t have to be traumatic. It doesn’t have to feel like your body is broken or doesn’t work.
It just needs to be supported—by evidence, by movement, and by people who believe your body was made for this.
Final Thoughts
Birth isn’t just a moment—it’s a memory. One that stays with us emotionally and physically for years. So why not set yourself up with the tools, the team, and the positions that support the body’s natural design?
Your pelvis is not passive. It’s a dynamic part of labor. So let’s stop boxing it in—literally and figuratively—by lying flat on a table. Let it move, let it open, let it help.
And if you need support, we’re here for you.
At enCORE Physical Therapy, we believe that a well-informed mom is a well-prepared mom. Whether you’re a first-time parent or preparing for your fourth, your body deserves to be treated with knowledge and respect.
Ready to feel more confident and empowered in your birth plan? Come see us for pelvic floor therapy in Overland Park or Kansas City.
enCORE Therapy
Helping Kansas City moms move, birth, and heal better.
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