Janine Gard is a diploma qualified birth educator and founder of Bellies to Babies. She has taught more than 2900 parents to feel confident, informed, supported and prepared. This week Janine talks about labouring in an upright position.
For most of human history (until recently), women were free to move about during labour, they were in tune with their bodies and used upright positions that felt comfortable, eased the pain of contractions and made birth easier.
Some of the earliest records of labour show women adopting a sitting, squatting or standing position while in labour. An ancient sculpture from Egypt shows Cleopatra (69 - 30BC) kneeling down to give birth, surrounded by five attendants. Evidence of birthing stools and chairs date back to Babylonian times, and surveys conducted in 1882 and in 1961 have shown that the lying down position has never been the norm in traditional cultures.
When you think of birth, there's usually a common image that flashes to mind — a woman, red in the face, lying on a hospital bed with her legs in stirrups. This image, which we get from movies, TV shows, ads, commercials and just about every other type of media out there, has shaped the way we think about childbirth and how we are conditioned today.
Well, it turns out that the rise in popularity of the lying position didn't have much to do with women's experiences at all. According to several medical articles, royalty could have been to blame.
King Louis XIV, who ruled France from 1643 to 1715, played a huge hand in popularising the lying down position, for a very odd reason. According to legend (and a handful of medical scholars), Louis XIV — who had more than 22 children by both wives and mistresses alike — had a fascination with watching women give birth.
Lauren Dundes, a professor of sociology, wrote that Louis XIV "enjoyed" watching his mistresses give birth, and disliked the upright or squatting positions for "obstructing" his view of the process.
"Since Louis XIV reportedly enjoyed watching women giving birth, he became frustrated by the obscured view of birth when it occurred on a birthing stool, and promoted the new reclining position," wrote Dundes in the American Journal of Public Health.
"The influence of the king's policy is unknown, although the behaviour of royalty must have affected the populace to some degree."
It is reported that knowing the king was a fan of the lying position, the women from the kingdom, surrounding lands and lower classes began to adopt the practice to follow suit. Hence our conditioning to lying down to birth.
Birth moved from home into hospital during the 1900s. The medical model of maternity care became entrenched in society, along with the expectation that women would labour on a bed. Flat on their back, and sometimes with their legs in stirrups. There is a complete lack of evidence to support this physiologically dysfunctional birthing position, which simply came down to doctor preference, and subsequently, how they were then trained.
However, there are plenty of reasons NOT to lie down while in labour, which is fully backed by evidence and most of it comes down to gravity.
The significant advantages of giving birth upright are:
Allows gravity to assist you
Why work harder than you need to? Your uterus contracts out — or forward — from your body. When you're upright, you can work with gravity and your body's natural functions in labour. When you're lying down, you're bearing the brunt of weight and force, which is going against gravity.
Fewer interventions likely
When you're giving birth upright, making use of gravity and more effectively using your muscles, you're less likely to need interventions such as forceps or episiotomies. When you're working against gravity in a dysfunctional position, both you and your baby are more likely to need help.
Contractions will be more efficient
When you're upright, leaning forward and working with gravity, your contractions will become much more efficient. If you're lying on your back, your uterus will be contracting upwards, which is not working with your body, but against it.
It's going to hurt less
When you're off your back, you'll experience less pain than you will giving birth lying down. This is because you have all the weight on your back and you're working against gravity.
How about faster labour?
When you're working with gravity, in a position that your body and baby is designed to work well, your labour will likely be much shorter — lying down may slow your labour down.
Better oxygen flow for your baby
When you're lying on your back, you're bearing the full weight of the baby, your uterus, placenta and all that comes with it. Doing so puts pressure on important blood supplies in your own body. Compressing the blood supply also compresses the oxygen supply to your baby. By being upright, you'll provide a better oxygen and blood supply to your baby. In turn, this means that your baby will be less likely to experience fetal distress which may result in an assisted labour.
Let's increase your pelvic space
Lying down reduces pelvic diameter by about 30 per cent. Being upright opens up your pelvis, whereas lying down closes it up. So it makes sense that if you're upright to deliver your baby, you can open up your pelvis by around 30 per cent.
Lying down means you're pushing uphill
Pushing "uphill" against gravity can be ineffective and exhausting. Getting upright means you're pushing "downhill" instead
It starts with having a conversation with your partner, birth support and LMC, practise, practise, practise and then practise a few more. Before you're in labour, practise a few upright positions, there are many great graphics online which will give you plenty of ideas if you're stuck for inspiration. Trying these beforehand will give you added tools so you're not scrambling in the middle of labour trying to figure out what position you might try next.
That's the thing with birth, you can plan, and think, and dream, and imagine what it's going to be like, but until it actually happens — it's a pretty universal experience where everyone says, "I didn't think it would be like that."
I would empower women to be confident that they can move into different positions, and not to feel like there is a "right" way to do things. The right way is what feels comfortable at the time.
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Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.