- Childbirth positions
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The term childbirth positions (or "maternal birthing position")[1] refers to the various physical postures the pregnant mother may assume during the process of childbirth. They may also be referred to as delivery positions or labor positions.
In addition to the lithotomy position still commonly used by many obstetricians, positions that are successfully used by midwives and traditional birth-attendants the world over include squatting, standing, kneeling and on all-fours, often in a sequence.[2]
Contents
Lithotomy position
In the lithotomy position the mother is lying on her back with her legs up in stirrups and her buttocks close to the edge of the table.[3] This position is convenient for the caregiver since it enables him or her more access to the perineum. However this is not a comfortable position for most patients considering the pressure on the vaginal walls due to the baby's head is uneven and the labor process is against gravity.[4]
Squatting position
The squatting position increases pressure in the pelvic cavity with minimal muscular effort. The birth canal will open 20 to 30% more in a squat than in any other position. It is recommended for the second stage of childbirth.[5] As most Western adults find it difficult to squat with heels down, compromises are often made such as putting a support under the elevated heels or having another person support the squatter.[6] This position may be difficult to maintain during the birth process since it can become uncomfortable or tiring. The squatting position opens the pelvis outlet and stretches the perineum naturally making it easier to push. An advantage to this is that there is even pressure on the vagina from the head of the baby.[4]
All-fours
Some mothers may choose this position instinctively. It can help the baby turn around in the case of a malpresentation of the head. Since this position utilizes gravity it also decreases back pain.[4] The reduction of back pain is due to the ability for the mother to tilt her hips.[7]
Side laying
Side laying may help slow the baby's descent down the birth canal giving the perineum more time to naturally stretch. To assume this position the mother lies on her side with her knees bent. To push a slight rolling movement to be propped up on one elbow is needed while one leg is held up. This position does not use gravity but still holds an advantage over the lithotomy position since it does not weigh the vena cava under the uterus so that blood flow to both mother and baby are reduced.[4]
Other useful information
Various people have promoted the adoption of these various birthing positions, particularly squatting, for Western countries, such as Grantly Dick-Read, Janet Balaskas, Moysés Paciornik and Hugo Sabatino. The adoption of these non-lithotomy positions is also promoted by the natural childbirth movement.
Different positions may be associated with different rates of perineal injury.[8][9]
References
- ^ Olson R, Olson C, Cox NS (May 1990). "Maternal birthing positions and perineal injury". J Fam Pract 30 (5): 553–7. PMID 2332746.
- ^ Engelmann GJ Labor Among Primitive Peoples (1883)
- ^ http://www.birthingnaturally.net/barp/lithotomy.html
- ^ a b c d http://www.childbirthsolutions.com/articles/birth/pushingpositions/index.php
- ^ Russell JG. Moulding of the pelvic outlet. J Obstet Gynaecol Br Commonw 1969;76:817-20.
- ^ Balaskas J Using the squatting position during labour and for birth
- ^ http://www.womenshealthmatters.ca/centres/pregnancy/childbirth/positions.html
- ^ Shorten A, Donsante J, Shorten B (March 2002). "Birth position, accoucheur, and perineal outcomes: informing women about choices for vaginal birth". Birth 29 (1): 18–27. PMID 11843786. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0730-7659&date=2002&volume=29&issue=1&spage=18.
- ^ Hastings-Tolsma M, Vincent D, Emeis C, Francisco T (2007). "Getting through birth in one piece: protecting the perineum". MCN Am J Matern Child Nurs 32 (3): 158–64. doi:10.1097/01.NMC.0000269565.20111.92. PMID 17479052. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0361-929X&volume=32&issue=3&spage=158.
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