Healthy Birth Blog Carnival: Birthing On Our Backs

April 6th, 2010 by Dionna | 11 Comments
Posted in Pregnancy and Birth

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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)

I used my sister (Tammy) as a source of strength for lots of leaning and rocking during labor. Mom was always nearby to give a backrub or a reassuring pat.

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

11 Responses to:
"Healthy Birth Blog Carnival: Birthing On Our Backs"

  1. the Grumbles   thegrumbles

    Interesting! My son was also posterior, though we didn’t know it until after he came out. Luckily my nurse and doctor saw me flailing around on the bed and had me try some hands-and-knees pushing, which was much more productive, and then side-lying when I finally delivered. I had hoped to be semi-squatting or some other position where gravity would help but in the heat of the moment… eh, the job got done.

  2. I’m so sorry your sister was treated that way. When I was in labor I felt the most uncomfortable when I was laying on my back. I ended up giving birth on my hands and knees while draped over a birth ball.

  3. Amber   AmberStrocel

    I’ve given birth twice – the first time was semi-sitting, and the second time was hands-and-knees. Somewhat ironically, I far preferred the more traditional semi-sitting and wanted to be in that position for my second baby, but in the act of pushing I couldn’t manage it. It’s amazing how it can feel totally impossible to roll over or move 2 feet when you’re in certain stages of childbirth. It’s intense, man.

    Regardless, in both births my caregivers were listening to me, and doing the best they could FOR ME. And so I feel good about it. I have an acquaintance whose first child was born 2 days after my second child, and she was made to move from hands and knees to her back for birth, which she didn’t like. I can understand that certain positions are more convenient for birth attendants, but surely their convenience matters MUCH LESS than a mother’s comfort and safety in birth!

  4. mamapoekie   mamapoekie

    Your sister being pushed into lying back is exactly what happened to me. It is so absolutely wrong how birth professionals abuse a mothers vulnerability to get them to do what makes things easier on them. I also wrote about it in my entry.

  5. curlymonkey   curlymonkey_

    I was lying on my back for 12 hours for my first child (hospital birth) and coached to push, I hated it! This is the reason why my second child was born at home (UC). Squatting was the way!
    Don’t get me start on the subject, I am a birth junkie now!

  6. Lauren @ Hobo Mama   Hobo_Mama

    Really interesting stories. I loved my pushing time because it finally relieved the back pressure and made me feel like I was really doing something. I was in much more of a sitting/reclining position than I’d thought I would be. I expected, based on my study beforehand, to want to push in a more active position, but reclining really worked fine for me. I mean, I wasn’t lying flat, but I was still surprised at how traditional-hospital-y it ended up being and yet it was perfect. I guess just going with what your body feels is right, huh? We tried squatting, and it was so intense that I couldn’t differentiate the pushing contractions and was trying to push all the time. Leaning back gave me and my body a chance to recover between urges.

    Speaking of which, I need my write my post for this carnival… :)

  7. With all my babies (4) I labored standing up but when it came to pushing I preferred a semi-reclined position. The longest I pushed was 15 minutes with the first, thirteen with the second, five with the third, and eight with the fourth, he was hung up on my pelvis(I actually scooted farther down so my lower back was flat and that freed him up). I think I had a short pushing stage b/c I stood up for all of my labor and baby dropped into position easier. My first two were hospital births and the last two were home births. The second was a horrendous hospital birth b/c I was put on the staff time table and when I got back on the bed my labor stalled out and they wouldn’t let me get back up. They hooked me up to a pit drip thinking they had lots of time and warned me of a c-section possibility, thirteen minutes later he came roaring into this world sending everyone hustling. Hence the homebirths for babies three and four.

  8. Melodie   bfmom

    I love reading birth stories. So interesting what works for some moms and not for others and how different hospital personnel interfere while others do not. I wish moms were given the freedom to choose what feels best for them all of then time though.

  9. Dionna   CodeNameMama

    Melodie – I totally agree. What works for one woman may be labor stalling for another.
    Thank you for all of the comments, ladies! I too, love birth stories. What a connecting thread between mamas :)

  10. I am so sorry for your sister!! That is horrible. I would have felt so angry. Changing positions is what may have saved Everett from being cesarean.
    He was posterior and my back labor was so intense I had a hard time feeling when contractions began and stopped so I had a lot of positions. I was happy to have a MW that let me move around, but at the same time disappointed because I was pushing in the same position (ironically, that was sort of semi-sitting) in a bath tub for over 2 hrs. I shouldn’t have been in there for so long or in that position, but she didn’t suggest anything and I was so in it I had no idea how long it had been or really didn’t notice what position I had ended up in. When we finally did move to hands-and-knees he was born in less than 45 minutes.

  11. michelle   TheParentVortex

    Yes, the freedom to move around is key and what works for one woman might not work for another. I moved from kneeling to standing while my 2nd daughter was crowning because I had an overwhelming urge to stand up – my midwife remarked afterwards that she’d never seen a woman do that before but it was exactly the right movement to bring my daughter down. She was born with her right arm up by her left ear, but she didn’t get stuck and I didn’t tear.

    Hooray for freedom of movement!

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