Here is an article entitled, “Peru Embraces Vertical Births to Save Lives.” How does birthing in an upright position save women’s lives? That’s a good question, because here in the good ol’ U.S. of A. most women give birth in a horizontal position, or some variation thereof, and our maternal mortality is less than that of Peru. Here’s how — women in Peru were hesitant to go to doctors, medical clinics, or otherwise place themselves in the hands of medical professionals when they were giving birth because they didn’t want to be in a horizontal position. So, Peru is encouraging these medical professionals to let the women give birth in old-fashioned, natural positions. This means that more women are going to doctors in the first place, and these women who are generally poor and at higher risk than the average American woman are going to be giving birth in a place where they can get quick medical help if necessary. The article mentions a woman who had to hike several hours from her home to the nearest medical clinic. Being several hours away from the nearest medical help is nearly unknown here in America, where most people probably live within an hour’s drive from a hospital. But there’s more to it than just that.
Peru’s health ministry has said vertical birthing positions can be healthier for women by reducing pressure on the uterus and large blood vessels that can affect the amount of oxygen going to the baby. Standing or sitting during childbirth also tends to reduce labor and delivery time, according to the health ministry, and allows the mother to watch the birth better than if she were lying down.
This link has some really good graphics of vertical positions — most of the typical drawings that depict labor or the birth of the baby show the mother in a horizontal position.
One of the commenters on this excellent blog post said,
After giving birth, it really seems like a special form of torture to force a woman to birth on her back. My worst contractions were the ones that happened when I was lying in bed. Agonizing.
Also in the comments, a doctor chimes in with how she helps women into good (vertical) positions, even when they’ve had epidurals — I strongly suggest that anyone who is currently pregnant or who may have another baby read those comments and bookmark the page for easy reference, so that you can know (and show your doctor, nurse, hospital) that it can be done, and some doctors are doing it! It’s far from typical, and you may need to do some serious campaigning and lobbying to assume these positions (even without an epidural when you have full control over your own body, but especially with an epidural when you’ll probably have to rely on nurses to help you into position), but it is so much better for you and the baby.
I’ll pull a couple of quotes from that doctor:
I have a policy of no operative vaginal delivery without trying a full squat first, and it almost always works. [This means no forceps or vacuum.]
My nurses were way skeptical at first, but after seeing a few babies come sailing out quickly in a squat they are all big believers now….
[On moving mothers numbed by epidurals] The hardest part is moving all the wires we have going with an epidural – external fetal monitor, external contraction monitor, urinary catheter, IV, epidural line, and blood pressure cuff. We have it down to a science now, though – we unplug everything that unplugs, pull all wires to one side, flip or move the mama, and replug everything in, passing them under the mama’s belly if we’ve moved to hands and knees. I enforce with my labor clients and my nurses that the mama’s comfort is our number one concern and the monitors are our job to keep track of. So mama moves as she needs to, and we chase the cords.
[She talks about how an active-birthing mom was very active during and between the pushing contractions…] Finally, she pushed out the baby’s head in a squat but almost sitting over one leg, so that leg was flexed and the other one a little extended, and then for baby’s big, tight-fitting shoulders, she first knelt, then leaned back on her hands and lifted her hips in the air and the little linebacker finally slid out…. The thing that always impresses me about a spontaneous second stage in an upright mother is that it’s not a matter of getting in one position and pushing the baby out, but most mamas move frequently including during contractions. In the 3 long pushing contractions she had, she probably changed position 15 times – and with that baby’s kind of sticky shoulders, I’m glad she was freely mobile and able to wiggle all over and push him out! That, in my experience, is what a true upright birth looks like! Most docs, though, would be driven nuts by having the baby be such a moving target (of course he was never more than a couple inches from the floor and could have easily just slid onto the pads on the floor) and having to get on the floor themselves.
For my own part, I cannot imagine lying down to give birth. It’s just too weird and unnatural. I was in hands-and-knees position for both births, and it was very beneficial. The pushing phase in my first birth lasted 40 minutes and I did have a 2nd-degree tear, although the baby was only average size; and my second birth took just a few contractions, no tears, and the baby was just a bit over 9 lb.
I just had to add a postscript here, because I just read something that totally boggled my mind. It was a comment from one L&D nurse on another L&D nurse’s blog, and she said that she had one mom with a “thick epidural” pushing in a semi-upright position because the woman had such severe nausea and vomiting when she was lying down. The doctor came in, and chastised the nurse because the mom was in a semi-sitting position. He believed that women could push better lying all the way down, because the baby had a better chance of going under the pubic bone. Somehow I doubt there is any evidence to support this hypothesis, yet a lot of evidence against it.
Filed under: birth choices, pushing Tagged: | baby, birth, C position, delivery, epidural, health, lithotomy, natural birth, peru, pregnancy, pregnant, squatting, supine, vertical birth, vertical delivery