Of bowels, birth and common sense: staying off your back during delivery

Sense and Sensibility is hosting the 5th Healthy Birth Blog Carnival, the theme chosen is : Avoid giving birth on your back and follow your body’s urges to push. So I thought I'd throw my 2 cents in!

If you look at the way birth is portrayed in our modern culture, you’d think the only way to give birth is laying flat on your back, with your legs up and some masked OB sitting between your legs yanking the baby out all the while you would be screaming your lungs out and cursing the world for what’s being done to your precious nether parts...

Well, turns out, it's probably the worst way to give birth! The lithotomy position actually narrows the pelvis, crushes your internal organs, decreases your blood circulation and forces you to work against gravity, going uphill, to push your baby out. Now, who on earth had that idea in the first place? Feminists would probably answer that it was the dominantly male medical world that first decided that it would be best for women to give birth that way. Historians may argue it was King Louis the fourteenth, who, wishing to see one of his favourite ladies give birth, asked that the lady be positioned on her back on a bed so he could have a better view... I think it really does not matter who first started this particularly poor habit in modern obstetrics, what matters is that we work to change that perception and help women birth in a more comfortable position, a position that makes sense.

I’ve been reading a fair bit about the fact that obstetrics are not so much based on evidence and science than on habits. The result is that women suffer interventions, poor positions and lack of proper support to suit the needs and comfort of their health practitioners. Many women and women’s health advocates argue that this situation needs to change. Women in labour need not to be submitted to unhealthy positions to suit other people’s comfort. If they were given the space and the right support to birth, chances are the intervention rates and outcomes for these women and their babies would be far better...

Now, what does common sense teach us? One of the analogies I really like, although some might find it kind of gross, is that of the bowel movement. Yes, there is another bodily function that no one likes to talk about, much less think about. Well, if you look closely at the way our body functions, it is much easier to have a proper bowel movement in an upright position. Who would ever think of having a bowel movement while lying down? No one right? Same goes with a baby being born. Newton taught us the importance of GRAVITY: gravity helps bring down whatever needs to come out of our bodies. So proper positioning is crucial when giving birth. Being upright, whether sitting on a birth stool, squatting, using ropes or a hammock to bear the body down, being on all fours and leaning against a bed, a birth ball or a support person, lunging or standing up really rocks! These types of positions can help the pushing stage be shorter, less painful for the mom and most of all, will probably help prevent much damage to the perineum.

The perineum... “Love thy perineum” should be a motto for all birthing women and their attendants... A healthy perineum is essential for a women’s health, even years after giving birth to their children. This bring me to the second point about the pushing stage: why on earth are practitioners still asking women to push before their body starts feeling the urge to push and why are they still advocating for women to forcibly push, using a vasalva maneuver, holding your breath and pushing pushing pushing? Research has proven that this type of pushing is actually bad for moms and their babies. It usually results in a much longer pushing stage, more tears and often leads to distress in the baby which in turn can lead to a caesarean section. Later on there may also be consequences for the mom’s health such haemorrhoids, weak perineum, pain during intercourse, leaks or prolapses.

Once more, common sense shows us how really ridiculous this is. As a biologist, I was privileged to witness a great many births in the natural world, especially in mammals such as ourselves. Why would humans be the only ones that give birth with so much pain and difficulties? It did not make any sense to me. Research has actually demonstrated that the human body does feel the urge to push when the baby is ready, that is when his head has properly molded to fit into the narrow pelvic opening. The head needs time to take the proper shape to slip pass the pubic bone. The perfect fit sometimes takes time... and does not obey any schedules, clocks or other means of timing. Most practitioners do not allow moms that time and forcibly encourage pushing once the mom is dilated to the proverbial 10 centimetres. Dilatation of the cervix is not all that is needed for a baby to be born: other delicate factors come in and should be taken into consideration.

In natural and “normal” birth, once the baby is ready, mom will feel the urge to push. She should be encouraged to go with the flow and as some have dubbed it “breathe baby down”. By using this slower, yet gentler technique, babies will experience less distress and slip out easily. Reminds you of something? Yes, back to the bowel movement. Straining when having a bowel movement is neither healthy nor helpful. It is much easier to just “go with the flow” and let your body (and gravity!) do the work. Straining results in pain, haemorrhoids and other distasteful things. Even when experiencing constipation, sometimes drinking more fluids and giving the body a few more hours will do the trick. In time, the body will resolve the issue. And so does it in birth, once the baby is properly positioned, gently breathing with the body’s urges to bear down will help baby be born without too much stress on the woman’s body, thus preserving the wonderful perineum!

This is really a circle, it brings me back to positioning: to be able to “breathe baby down”, women need to be helped in proper positioning. The upright position will help baby come down using gravity and help mom breath easily. Have you really tried breathing with your chin tucked in your chest? Not that easy right? Opening the chest and lifting the head is much better. And guess what? If mom breathes better, so does baby! Baby needs the oxygen to make his journey a little faster and littler easier.

Navelgazing midwife actually wrote an amazing post about helping a woman who had an epidural give birth sitting upright against the bed. This shows that even if you are hooked up to a electronic foetal monitor and an IV line, you can still find ways to get upright for the pushing stage.

None of this is rocket science; it’s just common sense and proper observation of how human bodies work. Bringing back common sense in labour and delivery rooms may just be what’s needed to get women to birth in a gentler and easier way, sparing lives that may be more endangered by overuse of technology, intervention and operations. “First, do no harm” remember? Technology should remain an exception, when there is clearly a life-threatening situation.

Birth remains a natural event and most women are capable of giving birth naturally if given the time, space and support, otherwise, how would the human species have survived this long?

So... going back to evidence-based science: much of what I lightly described above, including the analogy with the bowel movement, has really been observed, documented and proven by scientific research, so why is it that obstetrics are still the one medical area where the practices are more based on habits that on evidence and science? If I were a conspiracy-prone feminist, I could possibly argue that it’s just another way to rob women of their power in one event where their power is so obvious. So ladies, time to reclaim your birth power! Make sure you and your support team know how to birth in an upright position and enforce your choice with your health practitioners! Old habits can be change as long as a critical mass of change-makers is reached, let us hope that the bad habit of making women give birth in positions that do not suit them will soon disappear...

2 Responses so far.

  1. Anonymous says:

    Well said! Great stuff!!!

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