Birthing Position: When abnormality becomes the norm

One thing that is quite common to humans generally is the tendency to resist change, especially if the status quo has been seen as the norm for quite some time. Any other variation is considered an aberration.

So, you have carried your baby for nothing less than 36 weeks. Just when the positive feedback loop is about to be completed - you are in full labour and about to give birth, instead of being told to lie down on your back with your legs in squatting positions and your thighs opened, you are asked to sit, squat or kneel down - and then push. Sounds insane, right? maybe not totally.

As someone who grew up in a semi-urban, or should I say a semi-rural area, I have heard first-person narrations of how some women gave birth while working on the farm and virtually all of them did it in the alternate positions that are different from the normal position assumed by those giving birth in hospitals. Some even gave birth while supporting themselves with tree branches and other objects found around the farm. While complications might have occurred in some cases, none of those cases that were related to me had any with the birth process.

Humans are not the only primates that gives birth to their young ones. Other such as goats, dogs, elephants, etc., are also able to produce young ones through live births. Interestingly, all these animals take postures that are different from what we know as normal in humans while giving birth - they do it while standing.

Some might say that the likes of dogs, goats, etc, give birth in that position because they are quadruped mammals (they walk on their four legs). However, a look at the birthing posture in monkeys tells a similar story in that they mostly stand or squat while self-delivering their babies. In terms of ancestral closeness or evolutionary relationships, monkeys are the closest to humans.

^{source: flicker}

Arguments in favour of the supine position

The supine position refers to the normal position of women while giving birth - back lying, folded legs, and opened thighs. Women are usually asked to lie down horizontally on their backs with their faces and torsos facing up. In most cases (this may vary from region to region), the back of their head is supported with pillows to raise the head above the torso.

This is the default and the only position known to most nurses and midwives that attend to births. Thus, women in labour are told to assume this position without questioning. A research conducted by Okonta in 2012 reported that up to 99% of women in Nigeria gave birth using the supine position. Apart from the position being a universally known one, the argument of most medical folks is that it enables them to monitor labour and the birthing process easily, including the administration of medical procedures such as anesthesia (when needed). The fundamental question is, have they tried other positions in order to ascertain the easiest? Ask many of them this question and they will not be able to provide valid arguments to support their answers.

Alternate positions

Giving birth using alternate positions such as standing, crouching, squatting, etc., have a bit of history in the lives of humans. In fact, birthing in horizontal positions only evolved around the 17th century. What humans have been used to before then were alternate positions. Why did the birthing position evolve from these positions to what we currently know as normal?

Some scholars claim that the change in birthing position was a perverted caprice of King Louis XIV (1638-1715), a contemporary of Mauriceau (1637-1709).3°33 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. He also insisted on male accoucheurs attending births. The influence of the King's policy is unknown, although the behavior of royalty must have affected the populace to some degree. Louis XIV's purported demand for change did coincide with the changing ofthe position and may well have been a contributing influence. ^source

There is a host of proven evidence that supports the fact that giving birth in alternate positions actually has some benefits over the supine position. A silent pointer is the fact that many women in labour are told to assume vertical positions in to speed up the labour process. I have experienced this twice while my wife was in labour.

Apart from shortening the labour process, alternate birthing positions:

• helps the uterus to contract more strongly and efficiently
• enables flexibility in the pelvis and facilitates the extension of the outlet
• less risk of compressing the mother's aorta, better oxygen supply to the baby. ^source

If all these have been identified as to why alternate birth positions are better than the horizontal position, why then is the medical world fixated with the supine position? Apart from the ease of monitoring labour and delivery process that the supine position offers, are there other benefits that ake it preferable over standing, sitting, or squatting position?

What do you think?