Pushing Uphill – The Great Lying Down Lie

OK so another righteous ramble of mine about the dated methods of labour that still seem to be the majority and still are viewed as the “norm” (I am pleased to see opinion slowly changing on this one). So let’s talk just dive RIGHT in there and I’ll ask a (personal) question… When you are having a poo do you lie down on your back?

Are you sure? Wouldn’t that be the most appropriate and sensible way to do it? Hmmm?

So how about if you were reeeeally constipated? Surely you would lie down then wouldn’t you? to push it out?

No?

Sounds ridiculous doesn’t it? So why why why would anyone feel its a good idea to lie down to have a baby?! You are – in an anatomical and gravitational sense (try saying that when you’ve had a few) – pushing UP hill and round a corner, not just this – there is also the sacrum to take into consideration.  The only reason I believe the vast majority of women choose to lie down on their backs in labour because of 3 things:

1. The view of “that’s how its always been done and so that must be the best way” (Mum, Nan, Sister, Friend did it like that so its how I’ll do it)
2. Lack of education in active/natural birth methods and therefore going with what you get told to do (unless you request to give birth in a birthing centre and the suchlike you will always just be put forward to a delivery suite)
3. Lack of knowledge in the birth process and therefore opting for epidural pain relief (so you HAVE to lie down as your legs don’t work! Re epidurals – let’s not get started there ! We’ll deal with that one in a another post…)

This is such a shame and I’d really like to spread the word via this blog (and you can help me too girls) that this old fashiononed lying down method is just simply not the best method of birth.. Now don’t get me wrong – I’m all about choice but I’m afraid on this subject, its not a case of “oh here is another way you might like to consider trying” its a case of “oi love.. Why on earth are you giving birth lying down – seriously…? What are you thinking?!!” clear evidence shows it makes your birth longer, more difficult and your contractions more painful. For me its as daft as wearing wellies on your hands while you knit a jumper.

Now don’t just take my word for it – here comes the science bit, below are some exerts taken from the book “How Normal Childbirth Got Trapped on the Wrong Side of History ~ The Last and Most Important Untold story of the 20th Century” (if you’re interested in this kind of thing please try to find a copy of this online)

“Imagine that you are looking at an upright pregnant woman from the side as she labours and gives birth while still in an upright posture. If you had x-ray vision, you would see that the long stem of the ‘j’ shaped shaped birth canal of a childbearing woman tracks with the mother’s lower spine and the curved foot of the letter bends forward with the lower half of the birth canal. What this means is the pelvic outlet – the last 1/3 of the journey bends forward at a 60-degree angle. This requires the baby to go around a ‘corner’.  

Were you to look down into the pelvis from the top, you would notice that the big triangle-shaped bone at the very end of the spine — the sacrum and coccyx — encroaches into the pelvic outlet about half an inch. In this regard, the pelvis is like a hollow bowl with smooth walls on three sides but slightly bent in on the fourth side, making it impossible for anything that is the same size and shape as its upper circumference to pass through and out the bottom without seriously banging into this encroaching bony mass and perhaps being stopped by it.

However, in the second stage of labor, after the baby is squeezed out of the uterus through the cervix and begins its trek down into the birth canal, you would see something remarkable. The place where sacrum affixes to the lower end of the spine is itself a joint – that is, motion is technically possible – and the effects of pregnancy hormones makes this and other pelvic joints slightly movable. In addition, these hormones make the cartilage that holds the two sides of the pubic bone together. This pelvic joint also becomes unusually elastic. Thus the pelvic joints loosen somewhat and widen both front to back and side to side, giving the baby an extra 1-2 centimeters of room to negotiate its passage into the world.

Of course, this nifty trick ONLY works if the mother is standing, squatting or is in some other position that makes ‘right use’ of gravity and allows her sacrum to move back out of the way (similar to the way a pet door is pressed open by the dog or cat as it passes through). However, if the mother is bearing her own weight on her lower back, such as lying down with her legs held up in stirrups, the sacrum cannot move out of the way, and sometimes the trap door gets stuck in the closed position. When a woman tries to give birth lying down, not only must gravity be defied in order to push the baby uphill and around a corner, but she must do this with the doorway partially blocked, reducing the aperture of the pelvis by as much as a third.

If the baby is small or the mother’s pelvis is big, the forces of labor and extra effort on her part can overcome this impediment. However, for a mother who lying down, the baby will still have to be pushed uphill and will emerge in an upward angle (towards the ceiling). This is obviously a lot harder and may require the use of forceps or vacuum if the mother has had anesthesia. Unfortunately, if the reverse is true (a relatively big baby and/or small pelvis) the baby can get stuck, this would require a forceps delivery or a Cesarean.”

I hate to be a cynic but let’s face it, like most things that we are told to do in labour (in a delivery suite environment) its not entirely for the women’s benefit – its what is easier/quicker and cheaper for the doctor/hospital or whatever they deem necessary to do to you in order to avoid anything that may lead to them being sued… The only way we can all make a change to this is if we all arm ourselves with the best possible information and spread the word.

So anyway – the moral of the story is that its pretty obvious that lying down doesn’t just make your labour more prolonged, difficult, painful and potentially dangerous – it also leads to even MORE meddling by doctors. Once you jump on that road to intervention that’s when the flood gates open for all sorts of unnecessary medical procedures (I say unnecessary as if left to your own devices to give birth the way nature intended these methods are only needed in emergency cases) procedures such as epostomies, forceps/ventouse, epidurals… Before you know it you’re taking too long, using up their hospital bed and they are rushing you off for a caesarian.. Ladies my advice… DON’T get on your backs and anyway that’s is what got you in this predicament in the first place! 😉

So how did you give birth? Was it lying down? Squatting? In a pool? At home? On your head ;-)….?