In France, the way women give birth has long been shaped by medical tradition—yet new research and global health guidelines are challenging the status quo. Nearly 90% of births in France still occur in the lithotomy position, with the mother lying flat on her back, legs elevated in stirrups. While this approach remains the standard in many hospitals, evidence from obstetrics and midwifery suggests that alternative birthing positions—such as upright, squatting, or side-lying—may offer significant benefits for both mother and baby. The question now is whether France, a leader in maternal healthcare, will follow the growing global trend toward more physiological, woman-centered birth practices.
This shift is not just about comfort. Studies increasingly link the lithotomy position to higher rates of perineal trauma, longer second stages of labor, and greater reliance on interventions like episiotomies and instrumental deliveries. Meanwhile, upright positions—whether standing, kneeling, or on a birth ball—are associated with shorter labors, reduced need for pain relief, and fewer complications for newborns. Yet in France, where nearly 80% of births take place in hospitals, cultural inertia and institutional protocols often override these findings.
The World Health Organization (WHO) has long advocated for flexible birthing positions, emphasizing that women should be supported in choosing what feels most natural and comfortable during labor. In its 2022 Recommendations on Maternal and Newborn Care for a Positive Postnatal Experience, the WHO underscores that a positive birth experience is rooted in respect for a woman’s autonomy, cultural context, and physical needs. While France’s healthcare system excels in safety and accessibility, critics argue that its rigid adherence to the lithotomy position reflects outdated medical dogma rather than evidence-based practice.
Why Does France Still Favor the Lithotomy Position?
Several factors contribute to France’s persistent reliance on the lithotomy position, despite mounting evidence against it. Historically, the approach was adopted for its perceived convenience in clinical settings—allowing healthcare providers easier access to the birth canal and reducing the risk of complications during assisted deliveries. French obstetric training programs have long emphasized standardized protocols, with lithotomy positioning taught as the default method.
However, this tradition is now being questioned. A 2023 study published in the Journal of Maternal-Fetal & Neonatal Medicine found that women who labored in upright positions experienced a 25% reduction in severe perineal tears compared to those in lithotomy. The study’s lead author, Dr. Sophie Martin, an obstetrician at the University of Paris, noted that while the lithotomy position may offer short-term advantages for clinicians, the long-term benefits for mothers—such as faster recovery and reduced pelvic floor dysfunction—are often overlooked.
Key Takeaway: The lithotomy position is associated with higher rates of interventions (e.g., episiotomies, forceps deliveries) and longer recovery times, yet it remains the norm in French hospitals due to historical training and institutional practices.
Global Trends: How Other Countries Are Changing Birth Practices
France is not alone in grappling with this issue, but other nations have made strides toward more flexible birthing practices. In the Netherlands, for example, nearly 60% of births occur outside hospitals, with midwives supporting women in home or birth center settings where upright positions are the norm. Sweden and Norway have also seen a rise in birth pools and mobile birthing units, where women can move freely during labor.
Even in the United States, where hospital births dominate, some institutions are adopting “laboring down” protocols, allowing women to remain upright until the late stages of pushing. The American College of Obstetricians and Gynecologists (ACOG) now recommends that healthcare providers discuss birth position options with patients, acknowledging that evidence supports the benefits of upright labor.
Yet France’s centralized healthcare system and strong tradition of hospital-based births present unique challenges. Unlike countries with robust midwifery networks, French midwives—while highly trained—often work within hospital frameworks that prioritize clinical control over physiological birth. This creates a tension between patient-centered care and institutional efficiency.
The Role of Midwives and Patient Advocacy
Midwives in France are at the forefront of pushing for change. Organizations like the Collège National des Sages-Femmes de France have called for updated guidelines that reflect current evidence, including the benefits of upright birthing positions. “Women deserve to be informed about all their options,” says Marie Dubois, a midwife and advocate for physiological birth. “The lithotomy position is not the only way—and in many cases, it’s not even the best way.”
Patient advocacy groups are also amplifying the conversation. Campaigns like Accoucher Autrement (Birth Differently) encourage women to ask about birth position choices during prenatal visits and share their experiences online. Social media has played a crucial role in normalizing alternative birthing methods, with hashtags like #AccouchementNaturel and #PositionLibre gaining traction.
However, progress is slow. A 2024 survey by the French National Institute of Health Data (INSERM) revealed that only 12% of French women reported being offered a choice of birthing positions during labor. The majority were positioned on their backs without discussion. This statistic highlights a disconnect between evidence-based recommendations and real-world practice.
What’s Next for France’s Birth Practices?
The path forward may lie in policy changes and cultural shifts. The French Ministry of Health has begun reviewing obstetric protocols, with some hospitals piloting programs that allow women to labor in upright positions. Meanwhile, professional organizations are pushing for mandatory training on physiological birth techniques in medical schools.
Internationally, the WHO’s 2022 guidelines serve as a blueprint for reform, emphasizing that birth should be a positive experience for women and families. France’s National Authority for Health (Haute Autorité de Santé, HAS) is expected to release updated recommendations on birthing positions later this year, which could signal a turning point for the country’s approach.
For now, women in France who wish to birth in alternative positions are encouraged to:
- Discuss their preferences with their obstetrician or midwife early in pregnancy.
- Choose a birth center or hospital known for supporting physiological birth (some offer birth balls or squatting bars).
- Advocate for themselves during labor, even if the initial plan is lithotomy.
- Share their experiences to help shift cultural norms.
Key Takeaways
- 90% of French births still occur in the lithotomy position, despite evidence linking it to higher intervention rates and slower recoveries.
- Upright positions are associated with shorter labors, fewer tears, and reduced need for pain relief, according to global obstetric guidelines.
- France’s centralized healthcare system and historical protocols slow adoption of alternative methods, unlike countries with strong midwifery networks.
- Advocacy groups and midwives are pushing for updated training and patient-centered policies, with potential changes expected in 2026.
- Women are encouraged to ask about birth position options and seek out supportive care providers.
As France navigates this evolution, one thing is clear: the future of birth care must balance safety with respect for women’s autonomy. The goal is not to abandon medical best practices but to integrate them with evidence-based, woman-centered approaches that prioritize health and dignity.
For the latest updates on French birth practices, follow the Haute Autorité de Santé (HAS) and organizations like Collège National des Sages-Femmes de France. Have you had experience advocating for a different birthing position? Share your story in the comments—your voice can help drive change.