Though pushing in the supine position (on your back) with lots of coaching from doctors is the most common way women give birth in hospitals, evidence suggests this is neither optimal, “natural” nor particularly desirable for most women.
Supine pushing is certainly a familiar image to most of us, and more convenient for doctors, but it does mean that mom has to push the baby uphill with extra pressure on the perineum (the muscle between the vaginal opening and the anus). When laboring women are given the freedom to push in any position, they tend to get into some variation of a squat– maybe a squatting, holding on to a partner or squatting bar, or getting into an upright position via propping up the hospital bed, or lying on your side or getting on hands and knees.
Here’s a video that’s extremely helpful in showing you how positioning works. It’s worth watching to help you see how labor doesn’t have to be the flat-on-the-back experience it is in most movies. Women hate lying on their backs at the end of pregnancy (and are, indeed, told by doctors that it can be dangerous to do so!) so why would you want to lie on your back during labor? [youtube]http://www.youtube.com/watch?v=NjtM4EtSs34&feature=share&list=PLEE0133C59F77CF3B[/youtube]
Asking doctors to let you push in whatever position you want to push in is not always easy, the supine position is still very much entrenched in the birth culture. Just recently I was at a birth where the mom– who was on her back pushing, with two of us holding legs on either side of her–asked if she could get into a better position. Her doctor, a top OB/GYN at a leading NYC hospital, said, “research shows that this position allows for the widest possible pelvic opening.” The mom said, “But there’s no gravity to help.” The doctor snapped, “You can push standing on your head if you want, I don’t care.” And that ended that.
It’s hard to get up and move around and fight for something when you’ve been in labor for 27 hours … She pushed on her back with lots of very aggressive coaching and tore substantially to and around her anus. Who knows if the back pushing increased the tearing in this instance. Labor does work so well that back-pushing happens all the time and not everyone tears and not all tears are serious.
But know this: If you have an epidural it can be turned down so you can bear enough weight on your legs to push in a gravity friendly position. But you’ll likely need to be proactive about it. Talk to your care-provider now to find out if you will be supported to push in whatever position you want to push in. And talk to your partner, or whomever will be at your birth, about how he or she can support you when you’re very, very tired and wiped out at the end of labor.
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