Healthy Birth Blog Carnival: Birthing On Our Backs
This post is part of the Lamaze Healthy Birth Blog Carnival. The topic of this month’s carnival is “avoid giving birth on your back, and follow your body’s urges to push.”
A Tale of Two Labors
I recently had the great honor of helping coach my younger sister through her natural childbirth. I have no training as a doula or birth coach, but I have read extensively about natural childbirth and delivered my own son at a birth center (almost) drug-free.
My sister’s labor was significantly shorter than mine: she entered active labor around 10:00p.m., felt the urge to push around 1:10a.m., and only needed to push a handful of times before her beautiful son joined us Earthside.
As fast as her labor and delivery were, it still pains me a little to think about what was done to her. When she felt the urge to push, she was standing up and leaning against the hospital bed. She pushed once and her water broke (the midwife wanted to break it earlier, thankfully the midwife did not force the issue). She pushed twice and felt the baby descending.
At that point, the birthing team came into the room and literally forced Shawna to get on the bed. Shawna resisted. She was uncomfortable on the bed, and when the nurses forced her to lie down, she began to cry from the pain and pressure – not from the fact that the baby’s head was crowning – but because she had felt more comfortable and in control in the position she chose for herself previously.
Two pushes later, she was done, but the scene replays in my thoughts frequently. My own labor was complicated by the fact that Kieran was sunny side up. His posterior position made him get “stuck” at my tailbone (which was broken in the process). I pushed for six hours* in a variety of positions and ended up giving birth on the birthing stool. (1)
Luckily I was at a birth center with a midwife who was as determined as I was to get Kieran out safely, and vaginally. If I had been at that hospital and forced to lie on my back, I would have ended up being subjected to a cesarean section.
The fact that it took work to get Kieran to descend should not have been an automatic ticket to the operating room.
Birthing on Our Backs (or “Supine in the Stirrups”)
Both anecdotal and scientific evidence make clear that birthing lying down is not ideal. To begin with, lying down or in a semi-reclined position decreases the space of the birth canal up to 30%. Opening up the birth canal not only helps the baby descend, but it reduces risk of harm to the laboring mother. (2)
Risks to the mother include dislocation or fracture of the coccyx, increased strain and tearing, a higher risk of harm to the pelvic floor, possible increased hypotension & pregnancy-induced hypertension, less effective contractions, ineffective pushing and a general slowing of labor, and an increased risk of cesarean section. (3)
Because of this ineffective method of pushing, there are also risks to the baby. Those risks include pressure on the baby’s neck, excessive bruising and head molding, a broken clavicle, compression of the umbilical cord, disruption to the baby’s oxygen supply, and an increased need for vacuum or forceps delivery due to poor positioning. (4)
The Benefits of Effective Pushing
Getting off your back for active labor and the pushing stage has incredible benefits, not the least of which is a shorter, more comfortable labor and delivery. Effective laboring allows for more effective contractions and an increased sense of power and involvement. It allows the baby a better oxygen and blood supply and the opportunity to descend into the optimal birthing position. (5)
If you are planning an unmedicated birth, familiarize yourself with labor and birthing positions that are safer and more comfortable than lying down. Use gravity to aid your baby’s descent and to empower yourself.
I know it enabled me to birth my posterior baby without an epidural, without a vacuum or forceps delivery, and without unnecessary surgery.
*I should not have pushed for six hours – I did not feel the urge to push until about an hour before Kieran was born – but the midwife was worried about the amount of time that had already passed and asked me to try. I will save that story for another day.
(1) For descriptions and pictures of helpful labor positions, see “Positions for Labor,” available at http://www.lamaze.org/LinkClick.aspx?fileticket=SpYolBfPLnk%3d&tabid=792&mid=1751
(2) “Positioning for Prevention,” http://www.ubpn.org/index.php?option=com_content&view=article&id=67&Itemid=68
(3) Positioning for Prevention; see also “Episiotomy,” http://onyx-ii.com/birthsong/page.cfm?episiotomy
(4) Positioning for Prevention
(5) Positioning for Prevention; see also “Healthy Birth Practice #5: Avoid Giving Birth on the Back and Follow the Body’s Urges to Push,” http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/NonsupinePositions/tabid/485/Default.aspx
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"Healthy Birth Blog Carnival: Birthing On Our Backs"
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