Vertical birth

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.

6 Responses

  1. Actually the sitting position is NOT so good as the tail bone is curved and the baby has to move upward and over.
    Far better standing. squatting, kneeling, hands/hands. I love the book, WOmen Giving Birth,, Limburg & Smulders if you can find it. 1987, winner of the
    Most Valuable Birthing Book award from ME!!!!

  2. I would like to do a verticle birth – how do I get more info about health care providers who support this? I am in the military and have been assigned to a OBGYN -but in the end I can go to any hospital I want and insurance will cover. Would getting a Doula help in this matter? Looking for ideas…
    Thanks!

    • Lisa,

      I strongly recommend a doula in just about every circumstance. Choosing a doula who will advocate for you in this situation would be a definite plus! Talk to doulas in your area (you can do internet searches; DONA.org and CAPPA.net ought to have listings that you can use as a starting point) to see if they know of some OBs who are “natural” minded, and will support you in your desires. Also, try to get in touch with women in your area to see who they recommend and *why*. (The “why” is very important, because you will find some women who chose a particular doctor for exactly the opposite reasons that you might choose. You probably wouldn’t marry your friend’s husband just because she liked him; in just the same way, you shouldn’t pick a doctor just because a friend likes him.) You can call OBs (but you’ll probably have to set up a consultation), and ask them if they’re comfortable with catching the baby with you in a vertical position. Most of them will have never caught a baby like that, so expect some hesitation. I’ve heard that some doctors will not have a problem with women laboring in any position they choose, but will want the woman to lie down on the table/bed to give birth. From now until you give birth, you can try to sound out your doctor(s) to make sure that they will be a good match for you. Listen carefully to how they say what they say, because some people can be very good at making it sound like they agree with you, when in reality they’re just saying what they know you want to hear. You may also be able to have a midwife as an option (although you’ll want to interview them just like you would doctors, because some midwives are as stuck in the medical mindset as any doctor).

      I’m not sure if military insurance is different “regular” insurance, as to who and what they cover, but in most states, if midwives are legal, insurance would have to cover them — although there may be some more hoops to jump through or paperwork to fill out if the midwife is not a “preferred provider.” You may even be able to have a home birth (with CPMs or CNMs) covered by insurance in this way, but you’ll want to do your research to make sure. If you have a CNM in a hospital, you’ll likely be able to have insurance pay for it, although it will depend on your particular policy and preferred providers.

      In my opinion, it’s worth the extra cost to get a provider you’re comfortable with, who will work with you to do what you want and respect your wishes, and not try to coerce or threaten you into doing something you don’t want to do and is unnecessary anyway. This goes for doctors and midwives. And, depending on your insurance (if you have to pay a percentage of the final bill, as an example), you may end up paying less if you pay for a home birth out-of-pocket than a hospital birth that ends in a C-section; also, since different care providers have different rates for C-sections and other interventions, you may end up paying less for a hospital birth if you choose an out-of-network doctor/midwife who helps you avoid costly and unnecessary interventions, instead of going with a “preferred provider” who coerces or causes you to need a C-section. If you have a single charge (or no charge at all) for the birth, regardless of cost to the insurance company, then this becomes less important. But if the intervention is unnecessary, then it is worth avoiding even if it doesn’t make any difference in your pocket.

  3. […] Birth in Ecuador Posted on March 17, 2009 by Kathy In a previous post, I wrote about how that hospitals in Peru have embraced vertical birth in an effort to make […]

  4. I live in Nebraska where having a certified mid-wife attended home birth is not legal. (I plan on writing my congressman). So I chose a hospital where I’ve gone for years, and recently changed doctors to have someone a little less traditional attending my labor.

    Despite the fact that the hospital offers rooms with large water tubs, we are not actually permitted to give birth in the tub, we have to lay down on the bed during the pushing phase. This seems rediculous to me, so I asked the doctor, and she says it is for the doctor’s convenience. Now… I’m wondering the policy on disobeying doctor’s orders, because even though this is my first, I think I will be reluctant to get out for coached pushing.

    • Technically, the doctors and staff at the hospital must admit you if you’re in labor and abide by your wishes until the placenta is delivered, or they’ll be in violation of EMTALA. So, you have the right to give birth where and how you want. I’ve heard some stories, though, that show that that is not always the case — women who have been physically picked up and placed on the bed, rolled over, etc. [This is where extra pregnancy weight comes in handy, though, to discourage that. :-)] It comes down to a power struggle, and whether you want to fight during labor or not. It shouldn’t, but it might. Often, women are cowed by doctors or nurses into being “good little girls” and then follow orders; often women in labor are very open to suggestion, so if it is hinted that they should do X or receive Y, then they’ll acquiesce, even when they had said they didn’t want to, prior to being in labor.

      The problem with alternate birthing positions is that she has probably only ever seen birth with women on their backs, so it can be disorienting to her to attend a woman in any other birth position. She may object that she has never received a baby with the mom on hands-and-knees (or in some other alternate position), and you can laugh and say that you’ve never given birth on your back either, so it will be a first for both of you! You can catch more flies with honey than with vinegar. Alternatively, you can say that you are the one paying her, so you expect your wishes to be accommodated within reason, and it is certainly reasonable for you to give birth in some other position than lying on your back in bed, since that is so much harder for you and the baby. If you can find some information to present to her (unfortunately, you probably can’t get her to watch a video during your appointment — although perhaps downloading some YouTube videos and burning them to a DVD for her to watch at home might help [you can download them using <a href="http://www.keepvid.com&quot;KeepVid]) that discuss the benefits to mom and baby from physiologic birth positions, that may be helpful. But, I wouldn’t hold my breath — and even if she acquiesces during your prenatal appointment, that won’t mean that she’ll remember during your birth, nor that she’ll be the birth attendant. Remain optimistic, but also realistic.

      Other things you can do include having your husband well-versed in natural-birth philosophy, as well as hire a doula to help safe-guard your space and your plans. You will need to avoid drugs, so that you can use the birth labor tub, and also so that you can remain in control of your body during pushing so that you can avoid being on your back. Realistically, if you have an epidural and can’t feel your legs, you’re going to find it very hard if not impossible to be in any sort of position other than what others can put you in — probably on your back with your legs in stirrups.

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