Since time immemorial women have been active in labour. Myth suggests that it was Louis 14th’s desire to see his mistress give birth to his illegitimate child that prompted the fashion to lie down to give birth. More probable is that as birth moved from home to hospital and as obstetricians took over from midwives, the consequent interventions in the birth process required a woman to be immobilised. Regardless of the origin of lying down to give birth, science and anecdote have shown it to be a counter-intuitive and even a dangerous position in which to birth a baby.
Art work across the ages testifies to women birthing in upright positions- squatting, all fours, one knee up, standing holding ropes
G Engelmann did studies of tribal people in 1890s and found that most common position for birth amongst them was upright
What it means to have an active birth?
Physically An active birth is one where a woman is free to use upright and mobile positions during labour rather than lying down to give birth. There are many positions that she might adopt, though none are prescriptive. The key thing is that she is able to move as her instincts guide her, and not be instructed through her labour or inhibited by intervention, advice or cultural convention.
e.g. media representations of women women in asia accustomed to squatting, in west is not something we are necessarily physically or importantly emotionally in pictures showing active birth positions
Mentally An active birth is not simply one which involves the mother moving, but is also one in which she is an active participant in her own birth rather than a passive patient. Women report that being active in labour improves their birth experience, partly because they feel they have some control over their own birth and not simply subject to the authority of the medical establishment.
Choice, positive relationships, knowledge of the physiological needs of a birthing mother and a conducive environment are all important components in an active birth.
The history of modern childbirth has been one of women handing themselves over to be delivered of their babies- an active birth restores this balance, using obstetric intervention as and when it is necessary but respecting the natural process of birth when there is no compelling evidence to do otherwise.
Benefits of an Active Birth
1) Being upright means the mother is working with rather than against gravity. The baby’s head also exerts even and direct pressure on the cervix which sends strong signals to the mother’s brain, resulting in a more rapid first stage of labour. The spiralling descent of the baby is helped by a mother who is able to move and rotate her pelvis.
You can imagine that when lying down, baby’s head off the cervix…….labour sporadic, stop startish
2) The pelvis is up to 30 % larger when a woman is upright. The coccyx is able to move out of the way and the sacrum can expand leaving more space for the baby to pass through the pelvic canal.
Jean Sutton, OFP lady, talks about the ‘rhombus of michaelas’, this diamond shape on the back….when a woman moves into 2nd stage you can see it jutt out….in jamaica they have a saying ‘ a woman gives birth when her back opens up’ – this is what they are referring to….when lying down this can’t happen
3) There is a significantly reduced chance of a baby suffering from foetal distress when the mother upright. When a woman lies down late in pregnancy the main arteries that run from her heart to the placenta risk being compressed which reduces the oxygen flow to the baby.
Most commonly cited reason for emergency c-sections is foetal distress, more often than not if you ask woman what position she was in it was lying down……….baby and amniotic fluid, placenta etc weighs a minimum of 20 lbs at birth, huge weight, like a sack of potatoes……
4) Labour is significantly less painful than mobile and upright. During contractions the uterus tilts forward and when lying down this forward motion requires an extra exertion of energy, inevitably resulting in more pain. Anecdotes abound of women who cope with their labour until they are encouraged to lie down for an examination when they find the pain unbearable. As well as being more comfortable for the mother, a less painful birth reduces the need for pain relief and consequently reduces the possibility of a cascade of intervention arising from the administration of drugs.
Securing an Active Birth
2) Comfort, both physically and mentally in active birth positions
Includes carers and partners being comfortable too, so that their expectations don’t put mother off
3) Creating optimal conditions for birth- where environment enhances natural birth and mother feels empowered and uninhibited, thus behaving according to instinct rather than convention.
4) Respect for the process of birth. Instead of thinking of birth as something we do badly, understanding that we are designed to give birth and have been doing so successfully for centuries.