People have a variety of opinions on the ideal position from which to give birth. In the United States, and other developed nations, women often are automatically placed in a semi-reclined position during labor and delivery. But is this practice outdated? Does is go against the basic mechanics of the female reproductive system? Are we causing harm by putting the convenience of the birth attendant ahead of the woman? Some say yes.
The complications from childbirth can range from mild to severe, with severe tearing of the vagina and perineum, up to critical obstetric emergencies like postpartum hemorrhage. The reasons why the lure of the lithotomy seemed ideal in the 1950’s now should give us all pause. Let’s look at some of the more obvious contraindications for the semi-recumbent position:
The semi-recumbent position means that not only do women NOT utilize gravity and use the baby's own weight to help it move down, but it actually makes the mother work against gravity in order to push the baby out.
The major vessels leading to the uterus can be compressed, restricting blood flow to the baby
Historically, women in labor delivered their babies in squatting, supported squatting, kneeling and even standing positions.
One group's efforts indicate it’s time to push back against pushing during childbirth.
With the support of the Royal College of Obstetricians and Gynecologists, The Royal College of Midwives’ implemented a trial program at Medway Maritime Hospital in Kent. By simply not pressuring women to lie on their backs and “push,” the hospital reduced the number of third and fourth-degree perineal tears from 7 percent to 1 percent, an 85 percent reduction. Dot Smith, the hospital’s head of midwifery, blames the high number of tears on the misconception that women in labor need to “push, push and then push harder.”
We’d love to hear your experiences from the field. Have you encouraged women in your care to adopt a more natural childbirth position? Let us know!
Jean M. Bouquet, DO, is an Assistant Professor of Family Medicine and Co-Director of the Urban Underserved Track at the Rocky Vista University College of Osteopathic Medicine. He is the founder of the Bouquet Speculum, an innovative and FDA-cleared medical device that helps to screen women for cervical cancer. Dr. Bouquet also started the Cure Cervical Cancer nonprofit. The following blog post was written by Dr. Bouquet about his journey to creating the Bouquet Speculum.
Dr. Daniel Kimani is a trained and licensed medical officer in Kenya, holding a Bachelor of Medicine & Surgery, and a post-graduate certificate on basic oncology training. Dr. Kimani is the founder of the Global Cancer Care and Research Institute, and is an expert in clinical colposcopy — a procedure to examine the cervix, vagina, and vulva.