Thursday, November 27, 2008

The Supine Position for Birth

As I wrote about in "The History of Childbirth in America" post, birth, before it moved into the hospitals with doctors, usually took place in a vertical position. When doctors entered the picture, they presented a "quicker" way to have a baby -- something the midwives weren't offering -- the use of forceps. In order for a doctor to use the forceps, the woman had to lay flat on her back with her feet in stirrups. An episiotomy, a surgical cut to the vagina to make it larger, was performed in order to allow room for the forceps. If you have never seen forceps, they are giant "blades," inserted one at a time on each side of the baby's head. Babies often will have injuries or permanent scars from their use.

A woman needed forceps because she was drugged, often completely unconscious, and couldn't push her baby out. She was "delivered" by a doctor. This is where that term came from and still seems to be the word of choice today for giving birth to a baby. In every movie, sitcom, or TV drama, this is the position we see the mother laboring and giving birth.

When the uterus contracts, it tips forward. If a woman is laboring at home or has the freedom to move around, she will lean forward naturally during contractions, following what her body is telling her to do. She will move around, rocking her hips. She will squat. She'll spend time on her hands and knees. She will rest, laying on her side, not her back. She will have a natural desire to be in water, a warm tub or shower. All of these things are wonderful for her and for her baby.

If you choose to labor in a hospital, they will prefer you to stay in bed, on a monitor, not moving, so as to not make them have to readjust it every few minutes. This is painful for mom and does not help baby out. This is where most women request an epidural.

Stay out of that bed! Use gravity. It is good for your labor and you will dilate faster.

If a woman is listening to her body, not a doctor, the last thing she will hear is to lay flat on her back! This causes unnecessary pain! The supine position, or laying flat on your back, is a position that is convenient only for a doctor. This is where it is so interesting to know the history of childbirth and why we are affected by certain practices today. It reminds me of the story of the woman who always cut the ends off her ham before placing it in the roaster pan. She didn't know why she was doing it, but her mom always did it, so she thought that's just what you are supposed to do when cooking a ham. Later she found out that her mom did that because her pan was too small to fit the entire ham. We get so used to the way things are done, we forget to question why we started doing them in the first place, and certainly why we continue doing them.

You need to ask your doctor, or midwife, how they feel about you giving birth (not "delivering") in the position of your choice. Your answer should be along the lines, "This is your birth. Follow your body and do what you need to do." If the answer you get sounds more like, "Well, it's pretty hard for me to see what's going on down there if you are squatting on the floor!" you need to switch your birth attendant. Your birth is not about your doctor or midwife. It's about you, being in control, and giving birth in whatever position you need to. There are plenty of midwives who will support you and encourage you to follow your instincts.

I read an interesting fact recently about birth satisfaction. It said that women, whether they had pain medication or not, had a more satisfying birth experience if they were in control -- having choices and helping to make decisions about their birth. Taking a childbirth class played a huge role too, as then they were informed and felt capable in making decisions for themselves and their baby.

I also wanted to share another funny quote I recently read. It was in a book titled simply, "Childbirth Education," commenting on how an anthropologist from another country might view childbirth in the United States:

"During labor, the Vestal Virgins assume their positions around the woman, leading her in a variety of magical incantations with rhythmic breathing to blow off the magic spirits of pain. Finally when the time of delivery is near, the Vestal Virgins position the woman in one of the most torturous of the culture's institutions, a special apparatus used only at the time of birth. In it the woman is made to lie flat on her back with her legs and feet raised at a 90-degree angle and bent at the knee. It is thought that if a woman is able to deliver her baby in this almost impossible position, she will have passed the first initiation rites of motherhood."

A silly way of approaching a tradition of giving birth that really must be done away with, especially for women who have no drugs. The majority of my students do not have drugs, but are expected to give birth in this ridiculous position. If a woman is given a choice of birthing positions, she will most likely choose a position that allows her to use gravity.


Monica said...

Reading this brings back memories of my first birth and gets me all boiled up! The midwife I had said just another good push and I can help you a bit. I thought "oh good she'll do a massage and help the baby come out". Boy, was I wrong! She meant I'll just take this pair of scissors and cut you. That was the worst recovery, as you can probably imagine.

I find it mind boggling that laying on your back with your feet in stirrups is the "correct" and most known way to give birth. It just makes sense to have gravity on your side.

Kensie said...

Hey Donna! I am *loving* your blog, so much good information on here! I tried e-mailing you last week, but for some reason it kept getting sent back to me...I was just going to ask if you had DVDs available, so e-mail if you get a chance! Again, the blog is so awesome, you rock.