What is the lithotomy position?

The lithotomy position is often used during childbirth and surgery in the pelvic area.

It involves lying on your back with your legs flexed 90 degrees at your hips. Your knees will be bent at 70 to 90 degrees, and padded foot rests attached to the table will support your legs.

The position is named for its connection with lithotomy, a procedure to remove bladder stones. While it’s still used for lithotomy procedures, it now has many other uses.

The lithotomy position was the standard birthing position used by many hospitals. It was often used during the second stage of labor, when you start pushing. Some doctors prefer it because it gives them better access to both mother and baby. But hospitals are now moving away from this position; increasingly, they’re using birthing beds, birthing chairs, and the squatting position.

Research has supported the move away from a birthing position that meets the needs of the doctor rather than the woman in labor. A 2016 study comparing different birthing positions noted that the lithotomy position lowers blood pressure, which can make contractions more painful and draw out the birthing process. This same study, as well as another from 2015, found that a squatting position was less painful and more effective during the second stage of labor. Having to push the baby up works against gravity. In a squatting position, gravity and the weight of the baby help open the cervix and facilitate delivery.

Complications

In addition to making it harder to push during labor, the lithotomy position is also associated with some complications.

One study found that the lithotomy position increased the likelihood of needing an episiotomy. This involves cutting the tissue between the vagina and anus, also called the perineum, making it easier for the baby to pass through. A 2012 study similarly found a higher risk of perineal tears in the lithotomy position. Another study linked the lithotomy position with an increased risk of injury to the perineum when compared with squatting lying on your side.

Another study comparing the lithotomy position to squatting positions found that women who gave birth in the lithotomy position were more likely to need a Caesarian section or forceps to remove their baby.

Lastly, a study looking at more than 100,000 births found that the lithotomy position increased a woman’s risk of a sphincter injury due to increased pressure. Sphincter injuries can have lasting effects, including:

Keep in mind that giving birth is a complex process with many potential complications, regardless of the position used. In some cases, the lithotomy position may the safest option due to the baby’s position in the birth canal.

As you go through your pregnancy, talk to your doctor about possible birthing positions. They can help you come up with options that balance your personal preferences with safety precautions.

In addition to childbirth, the lithotomy position is also used for many urological and gynecological surgeries, including:

  • urethra surgery
  • colon surgery
  • removal of bladder, and rectal or prostate tumors

Complications

Similar to using the lithotomy position for childbirth, undergoing surgery in the lithotomy position also carries some risks. The two main complications of using the lithotomy position in surgery are acute compartment syndrome (ACS) and nerve injury.

ACS happens when pressure increases within a specific area of your body. This increase in pressure disrupts blood flow, which can hurt the function of your surrounding tissues. The lithotomy position increases your risk of ACS because it requires your legs to be raised above your heart for long periods of time.

ACS is more common during surgeries lasting more than four hours. To avoid this, your surgeon will likely lower your legs carefully every two hours. The type of leg support used can also play a role in increasing or decreasing compartment pressure. Calf supports or boot-like supports may increase compartment pressure while ankle sling supports may decrease it.

Nerve injuries can also happen during surgery in the lithotomy position. This usually happens when nerves are stretched due to improper positioning. The most common nerves affected include the femoral nerve in your thigh, the sciatic nerve in your lower back, and the common peroneal nerve in your lower leg.

Like childbirth, any type of surgery carries its own risk of complications. Talk to your doctor about any concerns you have about an upcoming surgery, and don’t feel uncomfortable asking questions about what they’ll do to reduce your risk of complications.

The lithotomy position is commonly used during childbirth and certain surgeries. However, recent studies have linked the position to an increased risk of several complications. Keep in mind that, depending on the situation, its benefits may outweigh the risks. Talk to your doctor about concerns you have about childbirth or an upcoming surgery. They can give you a better idea of your personal risk and inform you about any precautions they’ll take if they do use the lithotomy position.