DELIVERING WITH BOTH FEET ON THE GROUND
In several areas of Holland, midwives and the women under their care began to experiment with a number of spontaneous delivery positions used prior to the eighteenth century that had been almost forgotten by Western medicine. During the past two decades, these midwives have gained invaluable experience with vertical birth, the most natural and ancient method of delivery. (Third World nations have continued to use vertical positions for childbearing.) Exploration for alternatives to the current conventional birthing position did not come out of the blue; the disadvantages of delivering while lying on one’s back, in the supine position, have long been known.
First, a lot of time and energy is wasted on an unnecessary battle against gravity. Lying on her back- legs in the air, knees pulled up toward her chest and spread apart, chin on chest- is extremely tiring for a woman in labor. In essence, this is a horizontal squatting position, which does open up the pelvis and relax the muscles of the pelvic floor, though not as much as squatting when one is vertical. But “squatting” while on one’s back turns gravity into a hindrance rather than using it to assist delivery. The infeasibility of giving birth in the supine position is made very clear when one considers the position assumed for defecating, another expulsive functions of the body. We sit upright on the toilet, and when no facilities are available- on a camping trip, for example- we squat. It never occurs to us to lie down to have a bowel movement, and if someone suggested that we should do so, we wouldn’t take him or her seriously. If it weren’t for cultural conditioning, the idea of delivering supine- and thereby hampering a physiological process by going against the law of gravity- would strike us as equally absurd.
Pressure placed on main blood vessels within the pelvic cavity is another major disadvantage of supine delivery. The baby’s weight as well as that of the amniotic fluid and placenta presses onto the vessels that provide the blood flow into the placenta, blood flow which is vital for the child’s oxygenation.
In the seventies, many midwives rejected the supine position and switched to the semi-sitting position in which the woman half sits and half lies, supported by pillows, with her legs slightly bent and her feet flat on the mattress. A new problem arose; in this position, the woman’s weight tends to restrict the birth opening, leaving too little room for the baby’s head and shoulders. If a woman were to remain in this position, she would experience and uncomfortable counter-pressure from the mattress as the head descended and the anus began to bulge. This position is particularly unsuitable for a first-time mother, who must exert more strength to push her baby through the unprepared birth canal. If she is halfway between sitting and lying down, she cannot brace herself sufficiently. It is not without reason, after pushing in this position for a while without success, she is advised to lie down farther to provide more room for the head to pass through.
Midwives are finding that an increasing number of women prefer to remain positioned vertically during delivery. Squatting, sitting, kneeling, and standing facilitate the birth process for both mother and child. Awareness of the advantages of vertical birth is growing among doctors. In some hospitals, vertical delivery is already customary.
It goes without saying that a birthing position can be effective only if it is simple to assume, easily maintained, and very stable. During deliveries attended by midwives, many women intuitively went into the supported squat. The supported squatting position, because of its simplicity and stability, is an obvious position to choose. A partner sits on a sofa, chair, or bed behind her partner’s legs. She rests her arms on their thighs. If the pushing is prolonged for any reason, as it often is with a first child, the woman is supported by a small birth chair or by a bucket with a wide edge on which she can sit comfortably. This extra support is usually removed the moment the head presents itself, because during vertical deliveries from this point on, many women no longer need to push.
Some women shy away from the squatting position because they’ve heard the misconception that Western women have become totally unaccustomed to squatting and that they should take special courses to learn to squat from the third month of pregnancy on. Most women who have delivered in a squatting position have, in fact, practiced very little. Exercise during pregnancy is helpful but is not necessary.
A delivery in the supported squatting position is a joint effort in which both the woman and her partner are actively involved. Besides providing physical support during the squatting, the partner can instill in the woman a sense of security when she leans back to rest between contractions. Together they watch the child being born.
More and more often a woman will invite a girlfriend or someone with whom the couple is very close to attend the delivery. Their presence adds an extra dimension to the birth. Childbirth becomes more of a communal event. Having a girlfriend present gives the woman who is delivering a feeling of security, which helps relax her body, and the woman attending has a wonderful opportunity to experience a birth first-hand, gaining direct transference of knowledge rather than having to extract all her information from books.
The current developments in vertical birth have taken place primarily in women’s homes. This is understandable; for at home, in her own environment, surrounded by people of her choice, a woman feels free to take on her won position and to follow the signals of her body. Not only is the position altered but also the whole atmosphere around the birth changes. Consequently, the idea to which we have been conditioned for two centuries, that a bed is necessary for birthing, is no longer accepted as true. Hospital delivery rooms in which vertical deliveries are standard practice contain no beds. Bedrooms, often small and the chilliest rooms of the house are usually less than the ideal locations for home deliveries. A woman should choose the spot in her home that is most comfortable and warm.
The differences in emotions between a woman in a horizontal position and a woman in a vertical position are profound. In the vertical position, she “both feet on the ground”, she knows exactly what is happening, remains more herself, and is more involved with the delivery. The upright position is an optimistic position, making her feel strong. She can trust her body, which has been made to give birth and deliver with her own strength. She has equal status with those around her. This is not the case when a woman is in the supine position. She lies in a bed as if ill, and people tower above her, making her feel small and dependent. When the delivery does not go smoothly, she tends to surrender to the specialist and gives up responsibility.
Quite an unexpected development in terms of the mother’s first contact with the newborn child was made possible by the vertical delivery: she can see her child immediately and is the first person to hold her baby. When a woman delivers in the supine position, the midwife must actively assist the baby’s birth. It has been our experience that such intervention is usually unnecessary with vertical deliveries. The child is born by itself, due to the contractions and gravity, and the midwife merely catches it. The baby slides onto an obstetric pad on the floor in front of the mother. There are no time pressures; a woman can adhere to her own rhythm, recovering her breath and becoming attuned to her child at her own pace.
Early in your pregnancy, it is wise to discuss the type of delivery you envision with your midwife or obstetrician and to come to a full agreement with her or him. To find out during the delivery that your opinions about giving birth don’t correspond with their routine would be an unpleasant surprise. If you feel the midwife or doctor should stay in the background and leave you to initiate events, you should talk about this. Both parties must be absolutely clear and straightforward to ensure that the experience of birth is fulfilling to you and the others involved. Above all, keep in mind that this is your delivery, your child.
THE FOLLOWING ARE SOME ISSUES YOU MAY WANT TO RAISE:
1. Who will be at the delivery?
Ø Do you want only your partner to be present, or do you want to invite a friend, sister or mother?
Ø Do you want to hire a doula, a childbirth assistant, to accompany your birth team?
Ø If you have other children, do you want them to be there (or would their presence be distracting to you)?
2. Where are you going to deliver?
Ø At home, a birth center or in a hospital? If in a hospital, visit several in advance and ask about their regulations regarding birth position. Wherever you choose to deliver, be sure to visit one of their delivery rooms, the feeling you get from that room should be inviting, relaxing and peaceful.
Ø Does the birth location have a squat bar to attach to a bed or a squat stool to assist you if you choose to squat for delivery?
Ø If you decide to deliver at home, in what room will you give birth? Remember to take into consideration the size of the room, the noise level, and the heating. You will also want to decide if taking a bath/shower during labor or delivery sounds appealing to you.
3. Which positions appeal to you?
Ø Will you squat, stand, or kneel? Remember, that although practicing in your third trimester may be useful to you in delivery it isn’t essential.
Ø Will all of these options be available to you at the birth location you have chosen?
Ø Is your practitioner comfortable catching a baby in all of these positions? Do they routinely attend mother-led births or do they usually attend births where mom delivers in a bed? This will tell you a good bit of information about you likelihood of vertical delivery. The more experience they have with the variations of pushing positions they more confident they will be in following your lead.
4. What do you want to happen during your first contact with your child?
Ø Do you want anybody else to touch the baby besides you and your partner?
Ø Do you want to bathe the baby yourself or would you like your partner to do this?
Ø Would you like to get into the tub with the baby?
Ø Will you breastfeed immediately, if the baby is interested, or hold the baby skin to skin until s/he is ready for her first feeding?