When you think of a woman having a baby and the position she assumes, what do you see?
I’d always imagined what I saw portrayed in movies* and TV shows* – a woman labouring and pushing on her back. But is this the ideal birthing position?
The majority of Australian women (78%), do indeed assume this position when giving birth to bubs, but when you look at the evidence to suggest this isn’t the optimal position for labour, why the disconnect? Of course, labour and pregnancy alike are exhausting, and I love nothing more than kicking my feet up (not pregnant!) at any given moment, so I see how women gravitate towards the bed…but what does the evidence for everything but the bed, show?
In 2012, a Cochrane study, Gupta et. al was undertaken assigning 7,200 women into two groups; upright positions for birth (birthing stool, kneeling, squatting, all-fours) and non-upright positions for birth (semi-lying, lying down with bed head up, side-lying or in lithotomy (on your back, legs a part) .
When comparing the two groups, the women assigned to upright positions were:
- 23% less likely to have a forceps or vacuum-assisted birth
- 21% less likely to have an episiotomy
- 35% more likely to have a second-degree tear*, except when a “birth cushion” is used, in which case there was no additional risk of tearing (this statistic was somewhat offset with the decrease in episiotomy rates)
- 54% less likely to have abnormal fetal heart rate patterns
- 65% more likely to have blood loss greater than 500 mL** (this result was questioned due to the estimates of blood loss being estimates by varying health practitioners)
The result of this study concluded that women, without an epidural, should be encouraged to birth in upright positions due to the decreased risk of assisted deliveries (vacuum-assisted or forceps and episiotomy).
When breaking it down logically, being in an upright position – gravity is on your side; the weight of baby and the position of baby is better applied to the cervix…stimulating contractions…helping bub descend and move through the pelvis. Hey Presto!
A midwifery professor, Hannah Dahlen, wrote an article on The Conversation a few years ago, Stand and deliver- upright births best for mum and bub, that looked into why so many women in Australia, do indeed recline to have their babies. The short and simple may indeed be birthing unit design. Like most hospital rooms, the bed takes prime position (pretty convenient for the Midwives and Doctors). To their defence, many women do receive admission CTGs…so immediately they head on over to the bed, get comfy, and then…well 78%…
Being armed with the knowledge of positions to assume in labour, to help bubs work their way down, to relieve back pain etc., is worth investigating. Again, it comes down to what you want, so why not spice things up and try a few, this way you will find out what works for you.
*Movies – Knocked Up, Father of the Bride II, Nine Months, Juno, What to Expect When You’re Expecting
*TV shows – Offspring, Love Child