Freedom to Deliver - Modern Birthing Practices

There is generally no medical reason why women should be encouraged or required to lie flat on their backs for the delivery of their babies.
Contrary to the prevalence of this practice in western medicine, it appears that the best position for delivery may be an upright one.
Historical practices in childbirth indicate that the current trend toward recumbency deviates from the traditional practice of complete maternal mobility.
Before the use of physician centered practices became widespread, the most common position for laboring and delivering mothers was some form of the upright position.
There is also some criticism that medical settings are using practices that do nothing to enhance the health of the mother or the child.
Additionally, many westernized countries have been criticized for not allowing women more freedom in controlling their deliveries.
It is difficult to ignore the studies that provide increasing evidence against the use of the lithotomy position during labor and childbirth.
The use of modern medical interventions in a normal delivery should be avoided as well as the use of pitocin, analgesics and anesthetics, amniotomy, and the lithotomy position.
Women in most studies prefer to be ambulatory and upright during labor and delivery.
Research as far back as the 1930's has indicated that the use of an upright position may place the fetus in a position that is the most beneficial for cervical dilation and uterine descent.
Arguments for upright positions also include research that cites the benefits of reduced labor duration, fewer assisted births, lower incidences of episiotomies, and an increased likelihood of normal fetal heart rate patterns.
Researchers at the Karolinska Institute in Stockholm Sweden, have found evidence that women who elect to use the kneeling position during labor and delivery not only experienced less pain, but reported a greater satisfaction with the birth experience.
They believe that this may be due to the mobility of the pelvic region allowing for the pressure of labor to be released toward the lower spinal area.
The available literature emphasizes that this mobility in the lower spine may be crucial for lessening pain and easing the birth process, and that the positions most likely to allow for optimal pelvic mobility are those in which the mother labors and delivers upright.
With all of the available information regarding the possible benefits of an upright birth, one must wonder why women aren't encouraged to try other means of delivery rather than the traditional supine position.
It was in the early eighteenth century that an obstetrician in France introduced the supine position as an acceptable labor and delivery position.
This was for his convenience, not the mother's.
Since that time, women have labored against gravity in order to facilitate the birth process for the physician.
The risks associated with this position should be enough to warrant the use of any of the other numerous available positions.
Research has shown that the effects of the supine, dorsal recumbent and lithotomy positions are likely to have undesired effects on the maternal- fetal circulatory systems, uterine contractility and progress in labor, on fetal blood gasses and cord compression, and maternal pain and fear.
Episiotomies may be major factor in post partum pain, bleeding, infection, urinary and fecal incontinence, and dyspareunia, and note that a worthwhile goal in any successful delivery is an intact perineum.
An analysis of almost 3,000 births discovered that episiotomy rates are at their lowest during the lateral, or side lying, birthing position.
Upright positions potentially reduced the duration of the second stage of labor, but did not lessen the potential for an episiotomy or perineal tearing and that they may have an increased risk for maternal blood loss.
However, the traditional supine or semi-supine births had a more than 80 percent episiotomy rate when attended by a physician possibly due to physician training.
Even with the risk of perineal trauma, birthing in an upright position has a decidedly positive effect on delivery outcomes.
Several common difficulties, including failure to progress, retained placenta, postpartum hemorrhage, fetal distress, meconium staining, shoulder dystocia, and cephalohematoma were found to be significantly lower in a study group that used the squatting position during the second stage of labor.
This same study found that an increased risk for episiotomy was present only when the mother was advised to employ a pushing technique where she was instructed to hold her breath and bear down for as long as possible.
This advice certainly decreases the duration of the pushing stage, but increases the chance of an episiotomy.
Encouraging squatting in conjunction with only the involuntary urge to push was found to produce fewer lacerations and fewer episiotomies because of a much slower distention of the perineum.